The effect of scapular stabilization exercise in patients with subacromial impingement syndrome

Uvod: Subakromialni utesnitveni sindrom je utesnitev mehko tkivnih struktur, ki se nahajajo pod akromionom. Najbolj izpostavljena je tetiva mišice supraspinatus, ki je del rotatorne manšete. Do utesnitve struktur pride zaradi povečanih obremenitev, ponavljajočih gibalnih vzorcev, športov, ki zajemajo gibanje roke nad višino glave, nestabilnosti rame in lopatice, ter spremenjenega mišičnega ravnovesja in aktivacije. Namen: Namen diplomskega dela je na osnovi pregleda objavljene strokovne in znanstvene literature analizirati učinkovitost vadbenih programov za stabilizacijo lopatice pri subakromialnem utesnitvenem sindromu rame. Metode dela: V diplomskem delu smo uporabili opisno metodo s sistematičnim pregledom literature. Pri iskanju smo uporabili časovni okvir 10 let in uporabljena je bila elektronska podatkovna zbirka PubMed. Uporabljeni vključitveni kriteriji so bili: raziskave, dostopne v celotnem besedilu, v angleškem jeziku, in raziskave, ki so obravnavale subakromialni utesnitveni sindrom in vadbo za stabilizacijo lopatic. Rezultati: Med iskanjem literature je bilo pregledanih 47 strokovnih člankov, od tega je bilo 8, objavljenih med letoma 2011 in 2016, vključenih v pregled literature. Rezultati raziskav kažejo, da je stabilizacijska vadba, namenjena lopaticam, učinkovita za ohranjanje optimalnega subakromialnega porostora, zmanjšanje bolečine, izboljšanje funkcije zgornjega uda, obsega gibljivosti in drže pri subakromialnem utesnitvenem sindromu. Razprava in zaključek: Vključene raziskave so se med seboj razlikovale po sestavi rehabilitacijskega programa, 3 od njih so imele ciljno usmerjeno terapevtsko vadbo kot samostojno obliko fizioterapije, medtem ko je ostalih 5 izbralo kombinirano obravnavo. Pri slednjih je prišlo do težave z ocenitvijo učinkovitosti stabilizacijske vadbe, kot samostojne komponente. Smernice nakazujejo, da se je konzervativni pristop k obravnavi izkazal za najbolj učinkovitega, kar lahko opazimo z zelo primerljivim stanjem v primerjavi z enim letom po artroskopski subakromialni dekompresiji. V rehabilitaciji je pomembno aktivirati muskulaturo, ki stabilizira lopatico na prsni koš in mišice rotatorne manšete, ki stabilizirajo glenohumeralni sklep, ter s tem vzpostaviti optimalni skapulohumeralni ritem.Introduction: Subacromial impingement syndrome is the compression of the soft tissue structures, located under the acromion. The most exposed is the tendon of the muscle supraspinatus, which is part of the rotator cuff. The impingement of the structures occurs due to increased loads, recurrent movement patterns, overhead sports, shoulder instability and altered muscle balance and activation. Purpose: The purpose of this thesis is to analyze effectiveness of training programs for the scapular stabilization on patients with subacromial impingement syndrome based on the review of the published scientific literature. Methods: In this thesis we used descriptive method with a systematic review of the literature. For our research we took a ten-year time frame and collected data in the electronic database PubMed. Inclusion criteria used were: research available in full text in English language, research analyzing subacromial impingement syndrome and scapular stabilization. Results: We examined 47 articlesthereof 8 were published between years 2011 and 2016 and therefore included in our literature review. Results of the studies have shown that the scapular stabilization exercise is effective in maintaining optimal subacromial space, reducing pain, improving function of the upper limb and improving flexibility and posture. Discussion and conclusion: Involved research differed in composition of the rehabilitation program, 3 of them targeted therapeutic exercise as an independent form of physiotherapy, while the other 5 selected a combination treatment. In the latter cases, there was a problem with assessing the effectiveness of stabilization exercise itself as an independent component. The guidelines indicate that conservative approach to the treatment has proved to be the most effective and end results can be compared to one year after arthroscopic subcromial decompression. In rehabilitation it is important to activate musculature that stabilizes scapula on the chest and muscles of rotator cuff that stabilize the glenohumeral joint, thereby establishing optimal scapulohumeral rhythm