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Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis

Year 2022, Volume: 6 Issue: 1, 238 - 246, 27.01.2022
https://doi.org/10.30621/jbachs.1000917

Abstract

Purpose: Scapular dyskinesis is defined as alteration in scapular movements due to the loss of strength in scapular muscles; tightness of the soft tissues around shoulder and postural problems. Proprioceptive neuromuscular facilitation (PNF) is one of the therapeutic exercises to improve muscles weakness and pain levels. The aim of this study was to investigate the effects of a six-week PNF application on scapular muscle strength, scapular asymmetry, and pectoralis minor (PM) muscle tightness in participants with asymptomatic scapular dyskinesis.
Methods: Twenty-five asymptomatic participants were evaluated using the video analysis method to determine the scapular dyskinesis. Eleven of them diagnosed with scapular dyskinesis and recruited for the PNF application. Lateral scapular slide test (LSST); tightness of PM; the muscle strength of serratus anterior (SA); lower trapezius (LT) and upper trapezius (UT) were evaluated. Anterior elevation-posterior depression; posterior elevation-anterior depression of PNF patterns were applied as repeated contractions technique by 2 times a week during 6 weeks.
Results: The LT (p=0.012) and SA (p=0.035) muscle strength increased following PNF training, while UT muscle strength was similar (p>0,05). The UT/SA (p=0.035) and UT/LT (p=0.012) strength ratios decreased following PNF application. The mean differences of PM tightness and LSST did not exceed the established MDC%95.
Conclusion: Scapular muscle balance improved following scapular PNF training. Therefore, scapular PNF patterns would be considered as an alternative treatment option to provide scapular stabilization and increase muscle strength.

References

  • 1. Akodu AK, Akinbo SR, Young QO. Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates. J Taibah Univ Med Sci. 2018;13(6):528-534.
  • 2. Christiansen DH, Møller AD, Vestergaard JM, Mose S, Maribo T. The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome. J Hand Ther. 2017;30(2):208-213.
  • 3. Kibler WB, Sciascia A. Evaluation and Management of Scapular Dyskinesis in Overhead Athletes. Curr Rev Musculoskelet Med. 2019;12(4):515-526.
  • 4. Panagiotopoulos AC, Crowther IM. Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT J. 2019;5:29.
  • 5. Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes: A Systematic Review. Orthop J Sports Med. 2016;4(2):2325967115627608.
  • 6. Yeşilyaprak SS, Yüksel E, Kalkan S. Influence of pectoralis minor and upper trapezius lengths on observable scapular dyskinesis. Phys Ther Sport. 2016;19:7-13.
  • 7. Provencher MT, Kirby H, McDonald LS, Golijanin, P., Gross, D., Campbell, K. J. et al. Surgical Release of the Pectoralis Minor Tendon for Scapular Dyskinesia and Shoulder Pain. Am J Sports Med. 2017;45(1):173-178.
  • 8. Umehara J, Nakamura M, Nishishita S, Tanaka H, Kusano K, Ichihashi N. Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals. J Shoulder Elbow Surg. 2018;27(7):1214-1220
  • 9. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005;35(4):227-238.
  • 10. Voss DE, Ionta MK, Myers BJ, Knott M. Proprioceptive neuromuscular facilitation: patterns and techniques. 3th edition Philadelphia: Paul B Haeber; 1985.
  • 11. Adler SS, Beckers D, Buck M. PNF in practice: an illustrated guide. 3th edition. Springer; 2007.
  • 12. Westwater-Wood S, Adams N, Kerry R. The use of proprioceptive neuromuscular facilitation in physiotherapy practice. Physical Therapy Reviews. 2010;15(1):23-8.
  • 13. Anjum H, Amjad I, Malik AN. Effectiveness of Proprioceptive Neuromuscular Facilitation Techniques as Compared to Traditional Strength Training in Gait Training Among Transtibial Amputees. J Coll Physicians Surg Pak. 2016;26(6):503-506.
  • 14. Areeudomwong P, Wongrat W, Neammesri N, Thongsakul T. A randomized controlled trial on the long-term effects of proprioceptive neuromuscular facilitation training, on pain-related outcomes and back muscle activity, in patients with chronic low back pain. Musculoskeletal Care. 2017;15(3):218-229.
  • 15. Areeudomwong P, Buttagat V. Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial. Braz J Phys Ther. 2019;23(5):428-36.
  • 16. Kofotolis N, Vrabas IS, Vamvakoudis E, Papanikolaou A, Mandroukas K. Proprioceptive neuromuscular facilitation training induced alterations in muscle fibre type and cross sectional area. Br J Sports Med. 2005;39(3):e11.
  • 17. Lai CC, Chen SY, Yang JL, Lin JJ. Effectiveness of stretching exercise versus kinesiotaping in improving length of the pectoralis minor: A systematic review and network meta-analysis. Phys Ther Sport. 2019;40:19-26.
  • 18. Lempke L, Wilkinson R, Murray C, Stanek J. The Effectiveness of PNF Versus Static Stretching on Increasing Hip-Flexion Range of Motion. J Sport Rehabil. 2018;27(3):289-94.
  • 19. Marek SM, Cramer JT, Fincher AL, Massey LL, Dangelmaier SM, Purkayastha S, et al. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. J Athl Train. 2005;40(2):94-103.
  • 20. Balcı NC, Yuruk ZO, Zeybek A, Gulsen M, Tekindal MA. Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial. J Phys Ther Sci. 2016;28(4):1219-27.
  • 21. Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehabil. 2019;33(2):241-52.
  • 22. Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg. 2002;11(6):5506.
  • 23. Borstad JD. Measurement of pectoralis minor muscle length: validation and clinical application. J Orthop Sports Phys Ther. 2008;38(4):169-74.
  • 24. Odom CJ, Taylor AB, Hurd CE, Denegar CR. Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys Ther. 2001;81(2):799-809.
  • 25. Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther. 2005;85(11):1128-38.
  • 26. Bruton A, Conway JH, Holgate ST. Reliability: what is it, and how is it measured? Physiotherapy. 2000;86(2):94–99.
  • 27. Eliasziw M, Young SL, Woodbury MG, Fryday-Field K. Statistical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther. 1994;74(8):777-788.
  • 28. Hickey D, Solvig V, Cavalheri V, Harrold M, McKenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;52(2):102-10.
  • 29. Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-85.
  • 30. Lee SK, Park DJ. The Effects of Knee Joint and Hip Abduction Angles on the Activation of Cervical and Abdominal Muscles during Bridging Exercises. J Phys Ther Sci. 2013;25(7):857-860.
  • 31. Kofotolis N, Kellis E. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys Ther. 2006;86(7):1001-12.
  • 32. Hall EA, Docherty CL, Simon J, Kingma JJ, Klossner JC. Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. J Athl Train. 2015;50(1):36-44.
  • 33. Andersen CH, Zebis MK, Saervoll C, Sundstrup E, Jakobsen MD, Sjøgaard G, et al. Scapular muscle activity from selected strengthening exercises performed at low and high intensities. J Strength Cond Res. 2012;26(9):2408-16.
  • 34. Ha SM, Kwon OY, Yi CH, Cynn HS, Weon JH, Kim TH. Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome. J Electromyogr Kinesiol. 2016;26:130-6.
  • 35. Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24(3):173-9.
  • 36. Witt D, Talbott N, Kotowski S. Electromyographic activity of scapular muscles during diagonal patterns using elastic resistance and free weights. Int J Sports Phys Ther. 2011;6(4):322-332
  • 37. Peteraitis T, Smedes F. Scapula motor control training with Proprioceptive Neuromuscular Facilitation in chronic subacromial impingement syndrome: A case report. J Bodyw Mov Ther. 2020;24(3):165-71.
  • 38. Meneghini GO, Adamatti FS, Dhein W. Immediate effect of proprioceptive neuromuscular facilitation on scapular dyskinesia of volleyball players. MTP&RehabJournal 2020;18:1-9.
Year 2022, Volume: 6 Issue: 1, 238 - 246, 27.01.2022
https://doi.org/10.30621/jbachs.1000917

Abstract

References

  • 1. Akodu AK, Akinbo SR, Young QO. Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates. J Taibah Univ Med Sci. 2018;13(6):528-534.
  • 2. Christiansen DH, Møller AD, Vestergaard JM, Mose S, Maribo T. The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome. J Hand Ther. 2017;30(2):208-213.
  • 3. Kibler WB, Sciascia A. Evaluation and Management of Scapular Dyskinesis in Overhead Athletes. Curr Rev Musculoskelet Med. 2019;12(4):515-526.
  • 4. Panagiotopoulos AC, Crowther IM. Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT J. 2019;5:29.
  • 5. Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes: A Systematic Review. Orthop J Sports Med. 2016;4(2):2325967115627608.
  • 6. Yeşilyaprak SS, Yüksel E, Kalkan S. Influence of pectoralis minor and upper trapezius lengths on observable scapular dyskinesis. Phys Ther Sport. 2016;19:7-13.
  • 7. Provencher MT, Kirby H, McDonald LS, Golijanin, P., Gross, D., Campbell, K. J. et al. Surgical Release of the Pectoralis Minor Tendon for Scapular Dyskinesia and Shoulder Pain. Am J Sports Med. 2017;45(1):173-178.
  • 8. Umehara J, Nakamura M, Nishishita S, Tanaka H, Kusano K, Ichihashi N. Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals. J Shoulder Elbow Surg. 2018;27(7):1214-1220
  • 9. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005;35(4):227-238.
  • 10. Voss DE, Ionta MK, Myers BJ, Knott M. Proprioceptive neuromuscular facilitation: patterns and techniques. 3th edition Philadelphia: Paul B Haeber; 1985.
  • 11. Adler SS, Beckers D, Buck M. PNF in practice: an illustrated guide. 3th edition. Springer; 2007.
  • 12. Westwater-Wood S, Adams N, Kerry R. The use of proprioceptive neuromuscular facilitation in physiotherapy practice. Physical Therapy Reviews. 2010;15(1):23-8.
  • 13. Anjum H, Amjad I, Malik AN. Effectiveness of Proprioceptive Neuromuscular Facilitation Techniques as Compared to Traditional Strength Training in Gait Training Among Transtibial Amputees. J Coll Physicians Surg Pak. 2016;26(6):503-506.
  • 14. Areeudomwong P, Wongrat W, Neammesri N, Thongsakul T. A randomized controlled trial on the long-term effects of proprioceptive neuromuscular facilitation training, on pain-related outcomes and back muscle activity, in patients with chronic low back pain. Musculoskeletal Care. 2017;15(3):218-229.
  • 15. Areeudomwong P, Buttagat V. Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial. Braz J Phys Ther. 2019;23(5):428-36.
  • 16. Kofotolis N, Vrabas IS, Vamvakoudis E, Papanikolaou A, Mandroukas K. Proprioceptive neuromuscular facilitation training induced alterations in muscle fibre type and cross sectional area. Br J Sports Med. 2005;39(3):e11.
  • 17. Lai CC, Chen SY, Yang JL, Lin JJ. Effectiveness of stretching exercise versus kinesiotaping in improving length of the pectoralis minor: A systematic review and network meta-analysis. Phys Ther Sport. 2019;40:19-26.
  • 18. Lempke L, Wilkinson R, Murray C, Stanek J. The Effectiveness of PNF Versus Static Stretching on Increasing Hip-Flexion Range of Motion. J Sport Rehabil. 2018;27(3):289-94.
  • 19. Marek SM, Cramer JT, Fincher AL, Massey LL, Dangelmaier SM, Purkayastha S, et al. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. J Athl Train. 2005;40(2):94-103.
  • 20. Balcı NC, Yuruk ZO, Zeybek A, Gulsen M, Tekindal MA. Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial. J Phys Ther Sci. 2016;28(4):1219-27.
  • 21. Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehabil. 2019;33(2):241-52.
  • 22. Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg. 2002;11(6):5506.
  • 23. Borstad JD. Measurement of pectoralis minor muscle length: validation and clinical application. J Orthop Sports Phys Ther. 2008;38(4):169-74.
  • 24. Odom CJ, Taylor AB, Hurd CE, Denegar CR. Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys Ther. 2001;81(2):799-809.
  • 25. Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther. 2005;85(11):1128-38.
  • 26. Bruton A, Conway JH, Holgate ST. Reliability: what is it, and how is it measured? Physiotherapy. 2000;86(2):94–99.
  • 27. Eliasziw M, Young SL, Woodbury MG, Fryday-Field K. Statistical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther. 1994;74(8):777-788.
  • 28. Hickey D, Solvig V, Cavalheri V, Harrold M, McKenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;52(2):102-10.
  • 29. Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-85.
  • 30. Lee SK, Park DJ. The Effects of Knee Joint and Hip Abduction Angles on the Activation of Cervical and Abdominal Muscles during Bridging Exercises. J Phys Ther Sci. 2013;25(7):857-860.
  • 31. Kofotolis N, Kellis E. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys Ther. 2006;86(7):1001-12.
  • 32. Hall EA, Docherty CL, Simon J, Kingma JJ, Klossner JC. Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. J Athl Train. 2015;50(1):36-44.
  • 33. Andersen CH, Zebis MK, Saervoll C, Sundstrup E, Jakobsen MD, Sjøgaard G, et al. Scapular muscle activity from selected strengthening exercises performed at low and high intensities. J Strength Cond Res. 2012;26(9):2408-16.
  • 34. Ha SM, Kwon OY, Yi CH, Cynn HS, Weon JH, Kim TH. Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome. J Electromyogr Kinesiol. 2016;26:130-6.
  • 35. Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24(3):173-9.
  • 36. Witt D, Talbott N, Kotowski S. Electromyographic activity of scapular muscles during diagonal patterns using elastic resistance and free weights. Int J Sports Phys Ther. 2011;6(4):322-332
  • 37. Peteraitis T, Smedes F. Scapula motor control training with Proprioceptive Neuromuscular Facilitation in chronic subacromial impingement syndrome: A case report. J Bodyw Mov Ther. 2020;24(3):165-71.
  • 38. Meneghini GO, Adamatti FS, Dhein W. Immediate effect of proprioceptive neuromuscular facilitation on scapular dyskinesia of volleyball players. MTP&RehabJournal 2020;18:1-9.
There are 38 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Nazlı Büşra Ciğercioğlu 0000-0001-5912-4196

Ezgi Ünüvar 0000-0003-1606-3180

Polen Hazimlioglu This is me 0000-0002-6809-3042

Fırat Tan 0000-0002-9586-4041

Hasan Erkan Kılınç 0000-0002-6629-1619

Hande Guney Deniz 0000-0002-8315-8465

Publication Date January 27, 2022
Submission Date September 26, 2021
Published in Issue Year 2022 Volume: 6 Issue: 1

Cite

APA Ciğercioğlu, N. B., Ünüvar, E., Hazimlioglu, P., Tan, F., et al. (2022). Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis. Journal of Basic and Clinical Health Sciences, 6(1), 238-246. https://doi.org/10.30621/jbachs.1000917
AMA Ciğercioğlu NB, Ünüvar E, Hazimlioglu P, Tan F, Kılınç HE, Guney Deniz H. Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis. JBACHS. January 2022;6(1):238-246. doi:10.30621/jbachs.1000917
Chicago Ciğercioğlu, Nazlı Büşra, Ezgi Ünüvar, Polen Hazimlioglu, Fırat Tan, Hasan Erkan Kılınç, and Hande Guney Deniz. “Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals With Scapular Dyskinesis”. Journal of Basic and Clinical Health Sciences 6, no. 1 (January 2022): 238-46. https://doi.org/10.30621/jbachs.1000917.
EndNote Ciğercioğlu NB, Ünüvar E, Hazimlioglu P, Tan F, Kılınç HE, Guney Deniz H (January 1, 2022) Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis. Journal of Basic and Clinical Health Sciences 6 1 238–246.
IEEE N. B. Ciğercioğlu, E. Ünüvar, P. Hazimlioglu, F. Tan, H. E. Kılınç, and H. Guney Deniz, “Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis”, JBACHS, vol. 6, no. 1, pp. 238–246, 2022, doi: 10.30621/jbachs.1000917.
ISNAD Ciğercioğlu, Nazlı Büşra et al. “Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals With Scapular Dyskinesis”. Journal of Basic and Clinical Health Sciences 6/1 (January 2022), 238-246. https://doi.org/10.30621/jbachs.1000917.
JAMA Ciğercioğlu NB, Ünüvar E, Hazimlioglu P, Tan F, Kılınç HE, Guney Deniz H. Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis. JBACHS. 2022;6:238–246.
MLA Ciğercioğlu, Nazlı Büşra et al. “Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals With Scapular Dyskinesis”. Journal of Basic and Clinical Health Sciences, vol. 6, no. 1, 2022, pp. 238-46, doi:10.30621/jbachs.1000917.
Vancouver Ciğercioğlu NB, Ünüvar E, Hazimlioglu P, Tan F, Kılınç HE, Guney Deniz H. Proprioceptive Neuromuscular Facilitation Training Improves Scapular Muscle Strength and Pectoralis Minor Length in Individuals with Scapular Dyskinesis. JBACHS. 2022;6(1):238-46.