Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial

Hotta, Gisele Harumi; Couto, Amanda Gomes de Assis; Cools, Ann; McQuade, Kevin J.; Oliveira, Anamaria Siriani de

doi:10.1016/j.msksp.2020.102171

Cited by 22 publications

(35 citation statements)

References 49 publications

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“…The use of RCT design allows controlling for intervention-outcome confounding, but not for mediator-outcome confounding. The results of the Hotta et al [ 17 ] clinical trial demonstrated that there were no differences between the group that received additional scapular stabilization exercises with a focus on scapular retraction and scapular depression movements when compared to the muscle strengthening control group. Therefore, despite the effect of the intervention on the mediators was not significant, the causal mechanism of scapular orientation and muscle strength with pain and disability remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…The motor control intervention proposed in our clinical trial [ 17 ] was based on scapular retraction and depression movements, one possible explanation for the absence of intervention-mediators effect upon scapular position is that this intervention did not offered adequate motor stimulus to induce changes in motor behavior. Experimental paradigms have evaluated movement variability, systematic movement error and motor action planning and defined that kinematic accuracy and learning have limited generalization and are encoded in extrinsic coordinates [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…We included patients with positive results for 3 out of 5 SAPS tests: Neer, Hawkins-kennedy, painful arc, pain or weakness resistant to external rotation and Jobe [ 20 ]. The exclusion criteria were: history of shoulder trauma or surgery; total rotator cuff or biceps brachii tendon rupture (imaging exam or self-report); sports activities involving the upper limbs; individuals with neurological disorders and alterations in cognitive function (e.g., stroke, epilepsy, multiple sclerosis, Parkinson’s disease, and peripheral neuropathy); shoulder pain for primary involvement in the cervical or thoracic region; systemic disease involving the joints (e.g., rheumatoid arthritis); carpal tunnel syndrome; and underwent physiotherapeutic treatment of the shoulder in the last 6 months [ 17 ]. A detailed description of the trial was presented by Hotta et al [ 17 ] (clinicaltrials.gov: NCT02695524).…”

Section: Methodsmentioning

confidence: 99%

“…Participants assigned to the periscapular strengthening group (PSG) performed only six exercises of periscapular strengthening (upper trapezius, middle trapezius, lower trapezius, and serratus anterior). Participants allocated to the scapular stabilization group (SSG) performed the same six periscapular strengthening exercises applied to PSG, and six scapular stabilization exercises, emphasizing retraction and depression of the scapula, were added to this group [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…Considering the limitations of those studies, we conducted a randomized controlled trial (RCT) to evaluate the incremental effect of scapular stabilization exercises to a scapulothoracic strengthening program in people with SAPS [ 17 ]. The results of this study showed that no effects were found when added a scapular stabilization exercise to a scapulothoracic strengthening program for patients with shoulder pain on pain and shoulder disability.…”

Section: Introductionmentioning

confidence: 99%

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Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

et al. 2022

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Background Causal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome. Methods Sixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome. Results The results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability. Conclusion Scapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

et al. 2022

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Is exercise therapy the right treatment for rotator cuff‐related shoulder pain? Uncertainties, theory, and practice

Powell,

Lewis,

Schram

et al. 2024

Musculoskeletal Care

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BackgroundExercise therapy is a popular non‐surgical treatment to help manage individuals with rotator cuff‐related shoulder pain (RCRSP) and is recommended in all clinical practice guidelines. Due to modest effect sizes, low quality evidence, uncertainty relating to efficacy, and mechanism(s) of benefit, exercise as a therapeutic intervention has been the subject of increasing scrutiny.AimsThe aim of this critical review is to lay out where the purported uncertainties of exercise for RCRSP exist by exploring the relevant quantitative and qualitative literature. We conclude by offering theoretical and practical considerations to help reduce the uncertainty of delivering exercise therapy in a clinical environment.Results and DiscussionUncertainty underpins much of the theory and practice of delivering exercise therapy for individuals with RCRSP. Nonetheless, exercise is an often‐valued treatment by individuals with RCRSP, when provided within an appropriate clinical context. We encourage clinicians to use a shared decision‐making paradigm and embrace a pluralistic model when prescribing therapeutic exercise. This may take the form of using exercise experiments to trial different exercise approaches, adjusting, and adapting the exercise type, load, and context based on the individual's symptom irritability, preferences, and goals.ConclusionWe contend that providing exercise therapy should remain a principal treatment option for helping individuals with RCRSP. Limitations notwithstanding, exercise therapy is relatively low cost, accessible, and often valued by individuals with RCRSP. The uncertainty surrounding exercise therapy requires ongoing research and emphasis could be directed towards investigating causal mechanisms to better understand how exercise may benefit an individual with RCRSP.

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Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool

Kararti

Basat

Özsoy

et al. 2022

JOIO

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Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial

Cited by 22 publications

References 49 publications

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

Is exercise therapy the right treatment for rotator cuff‐related shoulder pain? Uncertainties, theory, and practice

Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool

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