【論文摘要】The Effects of the Manual Therapy and Scapular Orientation Exercise for Individuals With Pectoralis Minor Tightness and Shoulder Pain

【論文摘要】對於胸小肌緊繃之特定治療在肩痛及胸小肌緊繃患者之療效

李怡甄(Yi-Zhen Li) ； 林吟亮(Yin-Liang Lin)

《物理治療》 47卷4期 (2022/12) Pp. 298-298

https://doi.org/10.6215/FJPT.202212.O27

摘要

Background and Purpose: Scapular kinematics during motion is a critical component of normal shoulder function. Short pectoralis minor (PM) may prevent scapula from tilting posterior and rotating externally during shoulder motion, which may result in injuries and pain. The manual therapy, including soft tissue mobilization and proprioceptive neuromuscular facilitation (PNF) stretch, could specifically increase the flexibility of PM, and scapular orientation exercises could improve scapular kinematics. The purpose of this study was to determine the effects of this specific treatment approach (manual therapy and scapular orientation exercise) on length of PM, scapular kinematics, shoulder pain and shoulder function in subjects with shoulder pain. Methods: Thirty-three patients with shoulder pain and short/ tight PM were recruited and randomized into either a PM treatment group (n = 17) or a control group (n = 16). Both groups received 12 sessions of treatment in 4-6 weeks, with 30-40 minutes per session. The control group received general shoulder strengthening exercise, while the intervention group had additional manual therapy for PM and scapular orientation exercise. Outcomes included measures of PM length, scapular kinematics, shoulder pain, and shoulder disability. The scapular kinematics was measured with an electromagnetic tracking device. Independent t test was used to test the differences in changes of PM length, pain and disability between groups. Three-way mixed ANOVA was used to determine the differences in scapular kinematics between groups. Results: The experimental group demonstrated a significant increase in PM length (Cohen's d = 1.17, p = 0.011). Both groups demonstrated a significant increase in posterior tilting at 90° and 120° of arm elevation and 90° and 120° of arm lowering (d = 0.43-0.46, p = 0.015-0.021). Although improvement of pain and function in both groups exceeded minimal clinical important differences, no significant difference was found between groups. Conclusion: In the individuals with shoulder pain and short/tight PM, although the specific treatment protocol for PM increased the length of PM, this protocol was not more effective to improve scapular kinematics, shoulder pain and function than the general exercise. Clinical Relevance: The shoulder pain may result from multiple factors, so multifaceted treatment may be more effective for treating shoulder pain than the treatment targeting one structure.