Prone Row Exercise Versus Lateral Pull Down Exercise In Shoulder Impingement Syndrome With Scapular Dyskinesia

Overview

The purpose of this study is to compare the prone row exercise, and the lateral pull down exercise, in individuals diagnosed with shoulder impingement syndrome and scapular dyskinesia regarding latissimus dorsi strength, middle trapezius strength, lower trapezius strength, rhomboids strength, Visual analog scale score, Shoulder pain and disability index score and scapular stability test values.

Detailed description

Shoulder impingement syndrome (SIS) is a common musculoskeletal disorder, accounting for approximately 44-65% of all shoulder pain complaints. Normal scapular stability includes the ability to keep the scapula's normal position while the arms are at your sides and throughout all upper-limb movements . The upper, middle, and lower trapezius muscles couple with the serratus anterior and rhomboid muscles to form "force couples," which are thought to be important for appropriate scapular orientation.

Scapular dyskinesis occurs when the scapular stabilizing muscles (upper, middle, and lower trapezius, serratus anterior, and latissimus dorsi) are unable to preserve typical scapular movement, and is considered potentially harmful when it results in increased anterior tilting, downward rotation, and protraction, all of which reorient the acromion to reduce the subacromial space width.

Bilateral prone rowing has demonstrated clear clinical benefits for patients with subacromial impingement syndrome. In a four week, supervised program where 16 individuals with stage II SIS performed low rowing three times per week, The Lateral Pull down exercise is widely recognized for its activation of the latissimus dorsi, but it also significantly recruits scapular stabilizers such as the lower trapezius and rhomboids, especially when performed with proper scapular depression and retraction. This makes it an effective exercise for improving scapular muscle strength and control in both healthy individuals and those undergoing shoulder rehabilitation .

Fifty-four male and female patients, with age between 40-65 years (mean age of 52.5 ± 6.25 years) (Yilmaz et al., 2023), will be recruited through direct referrals from orthopedic doctors. They will be asked to sign the informed consent form.

The study will employ a two experimental group protocol. Each group will follow a distinct exercise intervention. Group A will perform the prone row exercise, while Group B will engage in the lateral pull-down exercise. Both groups will also receive selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises . The intervention period will last for 6 weeks, with sessions conducted three times per week under physiotherapist supervision.

Outcome measures:

1. Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using handheld dynamometer 2. Function using SPADI 3. Pain using VAS 4. Lateral scapular slide test using Kinovea The results of this study will help determine the most effective exercise approach for improving clinical outcomes in patients with shoulder impingement syndrome and scapular dyskinesia and may provide evidence to guide physical therapy practice.

Interventions

• Procedure Group A will perform the prone row exercise and selected physical therapy treatment
  prone row exercise: freely off the side and the head in a neutral position, supported if needed. The starting position involves 90-degree shoulder flexion with full elbow extension (0-degree elbow flexion), transitioning into 0-degree shoulder flexion with 90-degree elbow flexion. From this position, a bilateral vertical pulling movement is performed, involving scapular retraction and shoulder extension against resistance. The motion ends with the elbow flexed at 90 degrees, the shoulder extende
• Procedure Group B will receive selected physical therapy treatment and Lateral pull down exercise.
  The patient is seated on the pulldown machine with an upright trunk and feet flat on the floor, maintaining a stable posture. The starting position includes gripping the straight bar with a wide overhand (pronated) grip, marked to ensure a between-hands distance equal to 1.6 times the biacromial distance which is the horizontal distance between the most lateral points of the right and left acromion processes (shoulder tip). From this position, the participant performs a downward pulling movement

Primary outcome measures

• Lateral scapular slide test [Time frame: (pre-intervention) and after 6 weeks (post-intervention)]
• Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using Handheld dynamometer (HHD) [Time frame: (pre-intervention) and after 6 weeks (post-intervention)]
• Pain using the Visual Analogue Scale (VAS) [Time frame: (pre-intervention) and after 6 weeks (post-intervention)]
• Function using SPADI [Time frame: (pre-intervention) and after 6 weeks (post-intervention)]

Eligibility criteria

Inclusion criteria

• -Fifty-four male and female.
• Individuals diagnosed with SIS and aged between 40-65 years with right-hand dominance (Andrea et al., 2024).
• Participants experiencing shoulder pain persisting for a minimum duration of 3 months (Lucas et al., 2022).
• Subjects with a primary complaint of shoulder impingement and scapular dyskinesia according to Neer's classification specifically in stages I and II are referred by an orthopedist (El Melhat et al., 2025).
• Body mass index (BMI) is ≥ 25 kg/m² (Maryam et al., 2023).
• Individuals with a positive Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Kibler, 2003; Odom, 2001).
• All participants must have the cognitive ability to understand instructions and provide informed consent, consistent with standards highlighted in recent informed consent meta-analyses (Tam et al., 2015).

Exclusion criteria

• History of shoulder surgery, dislocation, or fracture (Crawshaw et al., 2010).
• History of neurological disorders (Crawshaw et al., 2010).
• Participants will be excluded if they had cervical spine pain or any signs of cervical radiculopathy (Magee, 2014).
• Individuals with chronic low back pain will be also excluded (Mohamed et al., 2022).
• Pregnant women will be excluded from participation in this study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Egypt · 1 center

• Faculty of Physical Therapy, Cairo University — Cairo

Publications

• Yilmaz Gokmen G, Akcay B, Kecelioglu S, Ozen MS, Yuce H. Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study. J Back Musculoskelet Rehabil. 2023;36(6):1375-1383. doi: 10.3233/BMR-220396. PMID 37694348
• Ronai, P. (2017). The barbell row exercise. ACSM's Health & Fitness Journal, 21(2), 25-28.
• Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991 Dec;4(4):143-9. PMID 11188601
• Obikili, E. N. (2006). Biacromial and Biiliac Diameters in a Young Adult Southeastern Nigerian Population. Journal of Experimental and Clinical Anatomy, 5(1), 22-25.
• 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 Feb;81(2):799-809. doi: 10.1093/ptj/81.2.799. PMID 11235656
• Noguchi M, Chopp JN, Borgs SP, Dickerson CR. Scapular orientation following repetitive prone rowing: implications for potential subacromial impingement mechanisms. J Electromyogr Kinesiol. 2013 Dec;23(6):1356-61. doi: 10.1016/j.jelekin.2013.08.007. Epub 2013 Aug 31. PMID 24055533
• McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther. 2004 Sep;84(9):832-48. PMID 15330696
• Lehman GJ, Buchan DD, Lundy A, Myers N, Nalborczyk A. Variations in muscle activation levels during traditional latissimus dorsi weight training exercises: An experimental study. Dyn Med. 2004 Jun 30;3(1):4. doi: 10.1186/1476-5918-3-4. PMID 15228624

Identifiers

NCT: NCT07577791 · P.T.REC/012/006445

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗