Cervical Stabilization Exercises IN Subacromial Impingement Syndrome

Shoulder impingement syndrome is a mechanical compression of the subacromial structures; specifically the subacromial bursa, rotator cuff, and long head of biceps tendons in the subacromial space. There are painful arm motions and functional restrictions.

The treatment of SIS focuses on improving pain and upper limb (UL) functions. Conservative treatments are effective in stages I or II of SIS.

Conservative treatments include non-steroidal anti-inflammatory drugs, corticosteroid injections, and exercise therapy such as strengthening for RC, and scapular muscles, stretching , proprioceptive neuromuscular facilitation (PNF), range of motion (ROM), and scapular stabilization exercises.

Cervical stabilization exercises (CSEs) can improve cervical spine stability, flexibility, muscular strength and endurance, and joint position sense. Shoulder stability extends beyond the shoulder joint as the head, neck, and shoulder are interconnected through muscles, tendons, and fascia.

Alteration of spine alignment leads to change mechanics of the shoulder. Forward head posture (FHP) can cause abnormal scapular orientation (internal rotation, elevation, and anterior tilting), decrease shoulder muscle strength, ROM, and increase humeral head translations that may predispose an individual to SIS. Also, increase thoracic kyphosis may cause increase scapular anterior tipping and retraction.

Crucially, the proper action of key scapular muscles, like the trapezius, requires the correct orientation of the cervical spine. This stability is achieved by the deep neck flexors (DNFs)-specifically the longus capitis and longus colli- which act as essential stabilizers for maintaining proper posture of the head and neck. Delayed timing of DNFs was shown to compromise spinal control during upper extremity function. Also, increased DNFs strength can enhance electromyographic (EMG) activity of scapular muscles (SA, UT, and LT).

One possible mechanism to describe the effect of CSEs in reducing pain is that stimulation of mechanoreceptors, including the muscle spindle and proprioceptors of joints. Signals from these receptors cause the release of endogenous opioids and beta-endorphins from the pituitary gland. Another possible mechanism of pain improvement is that the effect of these exercises in improving the coordination between the recruitment of the superficial and deep neck muscles. However, up to authors' knowledge, studies investigating the specific effects of adding CSEs to conventional SIS treatment are insufficient.

• Shoulder Disability will be assessed by shoulder pain and disability index [Срок оценки: Shoulder Pain and Disability Index will be assessed before the intervention and then after the end of the intervention at 6 weeks.]
• Kinesiophobia will be assessed by Tampa Scale of Kinesiophobia [Срок оценки: Tampa Scale of Kinesiophobia will be assessed before the intervention and the after the end of the intervention at 6 weeks.]
• Shoulder range of motion by inclinometer [Срок оценки: Shoulder Range of Motion will be assessed before the intervention and then after the end of the intervention at 6 weeks.]
• Muscles strength will be assessed by Hand Held Dynamometer. [Срок оценки: Muscles strength will be assessed before the intervention and then after the end of the intervention at 6 weeks.]
• Closed Kinetic Chain Upper Extremity Test [Срок оценки: Closed Kinetic Chain Upper Extremity Test will be assessed before the intervention and then after the end of the intervention at 6 weeks.]