Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, Brazil.
Disabil Rehabil. 2023 Sep;45(18):2925-2935. doi: 10.1080/09638288.2022.2114552. Epub 2022 Aug 24.
To investigate whether scapular movement training (SMT) is superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain.
A total of 64 individuals with chronic shoulder pain were randomly assigned to receive 16 sessions of SMT or SE over 8 weeks. Outcome measures included three-dimensional scapular kinematics, muscle activity of scapulothoracic muscles, pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes. Kinematics and muscle activity were assessed at baseline and after treatment, and self-reported measurements at baseline, 4, 8, and 12 weeks.
SMT significantly ( < 0.05) decreased scapular internal rotation during arm elevation and lowering at sagittal and scapular planes (mean difference [MD]: ranged from 2.8 to 4.1°), and at lower angles of arm elevation and lowering at the frontal plane (MD: 3.4° and 2.4°, respectively), increased upper trapezius (UT) activity (MD: 10.3%) and decreased middle trapezius (MT) (MD: 60.4%) and serratus anterior (MD: 9.9%) activity during arm lowering compared to SE. Both groups significantly improved pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes over 4 weeks, which was sustained over the remaining 8 weeks.
SMT is not superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain.
NCT03528499Implications for rehabilitationScapular movement training (SMT) showed small and likely not clinically relevant changes in scapular kinematics and muscle activity compared to standardized exercises.SMT and standardized exercises presented similar improvements in pain, disability, fear-avoidance beliefs, kinesiophobia, and self-perceived change in health condition immediately following 4-weeks of treatment, which was sustained over the following 8 weeks.The changes in patient-reported outcome measures are unlikely to be associated with changes in scapular kinematics and electromyographic activity.Clinicians should consider other factors than scapular movement during the treatment of patients with shoulder pain.
研究肩胛骨运动训练（SMT）是否优于标准化运动在改善肩部疼痛患者的肩胛骨生物力学、行为和临床方面更有效。
共有 64 名患有慢性肩部疼痛的患者被随机分配接受 16 节 SMT 或 SE，为期 8 周。结果测量包括三维肩胛骨运动学、肩胛骨肌肉活动、疼痛、残疾、恐惧回避、运动恐惧和自我感知的变化。运动学和肌肉活动在基线和治疗后进行评估，自我报告的测量在基线、4、8 和 12 周进行。
SMT 显著（<0.05）降低了矢状面和肩胛骨平面上肢抬高和降低时的肩胛骨内旋（平均差异[MD]：范围为 2.8 至 4.1°），以及额状面较低的上肢抬高和降低角度（MD：分别为 3.4°和 2.4°），增加了上斜方肌（UT）的活动（MD：10.3%），减少了中斜方肌（MT）（MD：60.4%）和前锯肌（MD：9.9%）在手臂下降时的活动。与 SE 相比，两组在 4 周内均显著改善了疼痛、残疾、恐惧回避、运动恐惧和自我感知的变化，这种改善在剩余的 8 周内持续存在。
SMT 在改善肩部疼痛患者的肩胛骨生物力学、行为和临床方面并不优于标准化运动。
NCT03528499
与标准化运动相比，肩胛骨运动训练（SMT）在肩胛骨运动学和肌肉活动方面仅显示出较小且可能不具有临床意义的变化。
SMT 和标准化运动在治疗 4 周后立即在疼痛、残疾、恐惧回避信念、运动恐惧和自我感知的健康状况方面表现出相似的改善，这种改善在接下来的 8 周内持续存在。
患者报告的结果测量的变化不太可能与肩胛骨运动学和肌电图活动的变化相关。
临床医生在治疗肩部疼痛患者时，应考虑除肩胛骨运动以外的其他因素。
