Scapular DyskinesisNCT06594809
Combination of Upper Extremity Proprioceptive Neuromuscular Facilitation and Scapular Stabilization in Nonspecific Chronic Neck Pain with Scapular Dyskinesia
A study testing PNF, Traditional neck pain treatment and Traditional neck pain treatment + Blackburn scapular stabilization exercises in people with Scapular Dyskinesis, run by Cairo University at 1 site in Egypt.
Trial summary
To study the combination of upper extremity PNF patterns and SS exercises on improving neck pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD. Read more about this study
- Who is it for?
- Ages 18 to 40 years
- Conditions the study is for
- Scapular Dyskinesis
- What is being tested?
- PNF, Traditional neck pain treatment and Traditional neck pain treatment + Blackburn scapular stabilization exercises
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 48 participants
- Where
- 1 siteEgypt
- Study dates
- Oct 2024to Jun 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 1- Have referred from orthopedic surgeon diagnosed with non specific chronic neck pain (NSCNP) that has been localized to the cervical and periscapular areas for at least three months.
- 2- Aged from 18-40 years. 3- Having a score more than 10 on the Neck disability index (NDI). 4- Having SD according to Kibler's description. 5- BMI from 18.5 to 29.9 kg/m2.
Who cannot join
- History of previous neck surgery.
- Recent or old fractures.
- Cognitive impairment and inability to understand the scale.
- Systematic inflammatory disease e.g., rheumatoid arthritis and ankylosing spondylitis, neck pain with radiculopathy or neuropathy.
- Scapular dyskinesia due to other pathology such as shoulder impingement.
- A score of below 10 or above 40 points out of 50 on the NDI.
Trial locations and contacts
1 site in 1 country.
About this study
To study the combination of upper extremity PNF patterns and SS exercises on improving neck pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
Read the detailed description
Nonspecific chronic neck pain (NSCNP) affects between 10.4% and 21.3% of office and computer workers, making it one of the most prevalent disorders that physical therapists treat. It frequently has a significant impact on daily living and necessitates the utilization of several healthcare resources.
NSCNP caused by Various factors-such as female sex, older age, high job demands, low social/work support, ex-smoker status, and a history of lower back disorders. Among them, the working conditions of office workers cause postural misalignment in the neck and shoulder regions. Patients with nonspecific chronic neck pain display altered dynamic scapular stability during scapular orientation.
The scapular bone connects the neck and shoulder and plays a very important role in stabilizing the neck and shoulder complex. Helgadottir et al., 2011 reported that patients who suffer from neck pain have malfunctions, such as decreased clavicular retraction and upward rotation. The axioscapular muscles, including the trapezius, serratus anterior, rhomboid major and minor, and levator scapulae, are attached to the scapular bone and can attribute to movement of the neck and shoulder complex. Several studies demonstrated that tightness and weakness of the axioscapular muscles could induce scapular dyskinesia (SD), which refers to abnormal scapular position or movement. Rehabilitation of NSCNP is highly supported by physical therapy with evidence-based interventions. Massage and ischemic compression target the surrounding muscles. These techniques decrease tension build-up, which directly improves spasticity and hyper-tonicity. Scapular stabilization exercises proved to be very advantageous in rectification of mal alignment of the neck. The scapular stabilization (SS) helps to correct muscular imbalances and gives early insight for activating superficial cervical muscles to perform a normal range of motion (ROM) and restores clavicular retraction and normal symmetry of the cervical-scapular region.
However, (Sciascia \& Kibler, 2022) reported that the identified maneuvers were often performed in an isolated manner with the body in horizontal (prone or supine) stationary positions could lead to a less than optimal rehabilitation outcome likely due to these exercises focusing on strength and encouragement of inefficient or improper motor patterns. Finally, if strength shouldn't be the focus, then it is possible scapular dysfunction is more likely rooted in issues related to motor control.
Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation concept which is widely used by physiotherapists and described as a comprehensive rehabilitation concept, promoting motor learning, motor control, strength, and mobility. Upper extremity PNF patterns are often included in exercises thought to affect recruitment of the scapular muscles. These patterns improve both muscular strength and flexibility as well as utilize sensory cues such as cutaneous, visual, and auditory stimuli to improve neuromuscular control and function. Incorporation of Upper extremity PNF patterns into shoulder rehabilitation programs may also be effective in treatment of SD.
Up to the authors' knowledge, there are no empirical reports or randomized control trials that have compared a motor control focused program against a program that focuses on strength of scapular muscles. Therefore, the purpose of this study was to study the combined effect of upper extremity PNF patterns and SS exercises on pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
- Conditions
- Scapular Dyskinesis
- Being tested
- PNF, Traditional neck pain treatment, Traditional neck pain treatment + Blackburn scapular stabilization exercises
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PNFOther
Upper extremity PNF exercise is an exercise method that dynamically stabilizes the scapula and affect scapular muscles activity (Witt et al., 2011). Upper extremity PNF patterns consisted of four diagonal patterns (D1 flexion, D2 flexion, D1 extension, and D2 extension) and six key components manual contact, body position, verbal cues pattern of movement, timing of movement and resistance. Patient will be at sitting position with involved side up, head, spine, and scapula in neutral
Traditional neck pain treatmentOther
Cervical muscles stretch + Craniocervical retraction ex + Manual therapy
Traditional neck pain treatment + Blackburn scapular stabilization exercisesOther
The patients will receive Traditional treatment of neck pain and Scapular stabilization exercises (Blackburn exercises). Blackburn exercises are one of the ways to treat scapular dyskinesia. Perform 2 sets of 20 repetitions of each exercise each session (3 sessions per week) for four weeks (panse et al .,2018). The exercise load will be 60% of the one-repetition maximum (1-RM) during the first week due to their first exposure to the exercises. The evaluation of one-repetition maximum (1-RM) will be every week for all exercises. From the second evaluation, more weight will be added (compare to the previous evaluation) to maintain the overload.
| Study group | Role | What they receive |
|---|---|---|
| Group one | Placebo comparator | Neck-focused training consisted of a) cervical stretching, b) craniocervical flexion, and c) cervical retraction exercises d) Manual therapy, for three sessions per week for four weeks (Yildiz et al., 2018). Receives: Other: Traditional neck pain treatment |
| Group two | Active comparator | The patients will receive Traditional treatment of neck pain and Scapular stabilization exercises (Blackburn exercises). Receives: Other: Traditional neck pain treatment + Blackburn scapular stabilization exercises |
| Group three | Experimental | Patients will receive combination of traditional treatment of neck pain, SS (Blackburn exercises) and upper extremity PNF patterns. Receives: Other: PNF |
What is being measured
The primary outcome is the main question the study is designed to answer.
scapular muscle strength
Hand-held dynamometer (HHD) (Model 01165, Lafayette Instrument Company, Indiana) is an easy and reliable device to assess isometric muscle strength for shoulder and scapular muscles in both clinical and research settings The patient will be instructed to maintain the midrange position during each muscle test as resistance was gradually applied via the HHD until the examiner matches the subject's effort Assess upper trapezius, middle trapezius, lower trapezius, and serratus anterior
Measured: up to 4 weeks
Assessment of scapular posture
Assessment of scapular posture by lateral scapular slide test, It used to determine scapula involves measuring the distance from the inferior angle of the scapula to the nearest vertebral spinous process using a tape measure or goniometer in three positions: shoulder in neutral, shoulder at 45 degrees of coronal plane abduction with hands resting on hips, and the shoulder at 90 degrees abduction with the arms in full internal rotation.
Measured: up to 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Sep 2024
- Study startOct 2024 (estimated)
- Primary completionMay 2025 (estimated)
- Study completionJun 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Scapular DyskinesisStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 48 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mohamed Ali Fathy Khalil, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06594809
- Sponsor's protocol ID
- Upper extremity PNF and SD
- Status last verified
- Sep 2024
- First submitted
- 9 Sep 2024
- Last updated
- 19 Sep 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 19 Sep 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Combination of Upper Extremity Proprioceptive Neuromuscular Facilitation and Scapular Stabilization in Nonspecific Chronic Neck Pain with Scapular Dyskinesia
- ClinicalTrials.gov ID
- NCT06594809
- Acronym / sponsor ID
- Upper extremity PNF and SD
- Conditions
- Scapular Dyskinesis
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 48 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- Oct 2024 (estimated)
- Primary completion
- May 2025 (estimated)
- Study completion
- Jun 2025 (estimated)
- First posted
- 19 Sep 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To study the combination of upper extremity PNF patterns and SS exercises on improving neck pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
Detailed description
Nonspecific chronic neck pain (NSCNP) affects between 10.4% and 21.3% of office and computer workers, making it one of the most prevalent disorders that physical therapists treat. It frequently has a significant impact on daily living and necessitates the utilization of several healthcare resources.
NSCNP caused by Various factors-such as female sex, older age, high job demands, low social/work support, ex-smoker status, and a history of lower back disorders. Among them, the working conditions of office workers cause postural misalignment in the neck and shoulder regions. Patients with nonspecific chronic neck pain display altered dynamic scapular stability during scapular orientation.
The scapular bone connects the neck and shoulder and plays a very important role in stabilizing the neck and shoulder complex. Helgadottir et al., 2011 reported that patients who suffer from neck pain have malfunctions, such as decreased clavicular retraction and upward rotation. The axioscapular muscles, including the trapezius, serratus anterior, rhomboid major and minor, and levator scapulae, are attached to the scapular bone and can attribute to movement of the neck and shoulder complex. Several studies demonstrated that tightness and weakness of the axioscapular muscles could induce scapular dyskinesia (SD), which refers to abnormal scapular position or movement. Rehabilitation of NSCNP is highly supported by physical therapy with evidence-based interventions. Massage and ischemic compression target the surrounding muscles. These techniques decrease tension build-up, which directly improves spasticity and hyper-tonicity. Scapular stabilization exercises proved to be very advantageous in rectification of mal alignment of the neck. The scapular stabilization (SS) helps to correct muscular imbalances and gives early insight for activating superficial cervical muscles to perform a normal range of motion (ROM) and restores clavicular retraction and normal symmetry of the cervical-scapular region.
However, (Sciascia \& Kibler, 2022) reported that the identified maneuvers were often performed in an isolated manner with the body in horizontal (prone or supine) stationary positions could lead to a less than optimal rehabilitation outcome likely due to these exercises focusing on strength and encouragement of inefficient or improper motor patterns. Finally, if strength shouldn't be the focus, then it is possible scapular dysfunction is more likely rooted in issues related to motor control.
Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation concept which is widely used by physiotherapists and described as a comprehensive rehabilitation concept, promoting motor learning, motor control, strength, and mobility. Upper extremity PNF patterns are often included in exercises thought to affect recruitment of the scapular muscles. These patterns improve both muscular strength and flexibility as well as utilize sensory cues such as cutaneous, visual, and auditory stimuli to improve neuromuscular control and function. Incorporation of Upper extremity PNF patterns into shoulder rehabilitation programs may also be effective in treatment of SD.
Up to the authors' knowledge, there are no empirical reports or randomized control trials that have compared a motor control focused program against a program that focuses on strength of scapular muscles. Therefore, the purpose of this study was to study the combined effect of upper extremity PNF patterns and SS exercises on pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Group one | Placebo comparator | Other: Traditional neck pain treatmentNeck-focused training consisted of a) cervical stretching, b) craniocervical flexion, and c) cervical retraction exercises d) Manual therapy, for three sessions per week for four weeks (Yildiz et al., 2018). |
| Group two | Active comparator | Other: Traditional neck pain treatment + Blackburn scapular stabilization exercisesThe patients will receive Traditional treatment of neck pain and Scapular stabilization exercises (Blackburn exercises). |
| Group three | Experimental | Other: PNFPatients will receive combination of traditional treatment of neck pain, SS (Blackburn exercises) and upper extremity PNF patterns. |
Who may qualify
- Ages
- 18 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (2 listed)
- 1- Have referred from orthopedic surgeon diagnosed with non specific chronic neck pain (NSCNP) that has been localized to the cervical and periscapular areas for at least three months.
- 2- Aged from 18-40 years. 3- Having a score more than 10 on the Neck disability index (NDI). 4- Having SD according to Kibler's description. 5- BMI from 18.5 to 29.9 kg/m2.
Key exclusion criteria (6 listed)
- History of previous neck surgery.
- Recent or old fractures.
- Cognitive impairment and inability to understand the scale.
- Systematic inflammatory disease e.g., rheumatoid arthritis and ankylosing spondylitis, neck pain with radiculopathy or neuropathy.
- Scapular dyskinesia due to other pathology such as shoulder impingement.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| PNFUpper extremity PNF exercise is an exercise method that dynamically stabilizes the scapula and affect scapular muscles activity (Witt et al., 2011). Upper extremity PNF patterns consisted of four diagonal patterns (D1 flexion, D2 flexion, D1 extension, and D2 extension) and six key components manual contact, body position, verbal cues pattern of movement, timing of movement and resistance. Patient will be at sitting position with involved side up, head, spine, and scapula in neutral | Other | Group three |
| Traditional neck pain treatmentCervical muscles stretch + Craniocervical retraction ex + Manual therapy | Other | Group one |
| Traditional neck pain treatment + Blackburn scapular stabilization exercisesThe patients will receive Traditional treatment of neck pain and Scapular stabilization exercises (Blackburn exercises). Blackburn exercises are one of the ways to treat scapular dyskinesia. Perform 2 sets of 20 repetitions of each exercise each session (3 sessions per week) for four weeks (panse et al .,2018). The exercise load will be 60% of the one-repetition maximum (1-RM) during the first week due to their first exposure to the exercises. The evaluation of one-repetition maximum (1-RM) will be every week for all exercises. From the second evaluation, more weight will be added (compare to the previous evaluation) to maintain the overload. | Other | Group two |
Primary outcome
scapular muscle strength
Time frame: up to 4 weeks
Hand-held dynamometer (HHD) (Model 01165, Lafayette Instrument Company, Indiana) is an easy and reliable device to assess isometric muscle strength for shoulder and scapular muscles in both clinical and research settings The patient will be instructed to maintain the midrange position during each muscle test as resistance was gradually applied via the HHD until the examiner matches the subject's effort Assess upper trapezius, middle trapezius, lower trapezius, and serratus anterior
Assessment of scapular posture
Time frame: up to 4 weeks
Assessment of scapular posture by lateral scapular slide test, It used to determine scapula involves measuring the distance from the inferior angle of the scapula to the nearest vertebral spinous process using a tape measure or goniometer in three positions: shoulder in neutral, shoulder at 45 degrees of coronal plane abduction with hands resting on hips, and the shoulder at 90 degrees abduction with the arms in full internal rotation.
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Sep 2024.
- Individual participant dataSharing planned: Yes
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing PNF, Traditional neck pain treatment and Traditional neck pain treatment + Blackburn scapular stabilization exercises in people with Scapular Dyskinesis, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Mohamed Ali ibrahim (002001061759217, mohamed.ibrahim@pt.cu.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
scapular muscle strength (time frame: up to 4 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2024.