OMUZ DİSFONKSİYONLARINDA SUBSKAPULARİS KASININ YUMUŞAK DOKU MOBLİZASYONUNUN AĞRI VE FONKSİYONELLİK ÜZERİNE ETKİLERİ
Öz
Amaç: Yumuşak doku mobilizasyonunda myofasyadadaki değişiklikleri düzenlemek amacıyla, kısalmış yapıların uzamasını sağlayan özel ve ilerleyici manuel güçlerin uygulanmasıdır. Bu çalışmada, omuz disfonksiyonu olan olgularda, subskapularis kasına uygulanan yumuşak doku mobilizasyonunun, eklem hareket açıklığını, fonksiyonunu ve ağrıyı arttırıp arttırmadığını, kısa ve uzun süreli değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntem: Çalışmaya, Başkent Üniversitesi Hastanesi Fizik Tedavi ve Rehabilitasyon kliniğine başvuran, ortalama yaşları 51,9±11,5 yıl olan 48 omuz patolojisine sahip olgular dahil edildi. Olgular iki gruba ayrıldı. Birinci gruba (25 kişi) sadece subskapularise yumuşak doku mobilizasyonu içeren 15 seanslık fizyoterapi programına alındı. İkinci gruba ise (23 kişi) Hotpack, TENS, US ve ev programından oluşan yine 15 seanslık fizyoterapi programı uygulandı. Olguların yaş, cinsiyet, boy, ağırlık bilgileri sosyodemografik veri formu ile kaydedildi. Omuz fleksiyon, abdüksiyon, internal ve eksternal rotasyon hareketleri gonyometre ve baş üstü uzanma testi ile, ağrıları görsel analog skalası ile, fonksiyonelliği Omuz Ağrı ve Disabilite İndeksi (SPADİ) ile değerlendirildi. Değerlendirmeler tedavi öncesi, hemen sonrasında ve tedavi bitiminden 3 hafta sonra fizyoterapistler tarafından yapıldı. Bulgular: Tedavi öncesi, hemen sonrası ve 3. Hafta sonunda yapılan değerlendirmelerde, birinci ve ikinci grupta ağrı, omuz fleksiyon ve eksternal rotasyon eklem hareket açıklığında, baş üstü uzanma seviyelerinde istatistiksel olarak anlamlı iyileşme bulundu (p<0,05). Her iki grupta SPADİ, ağrı ve disabilite skorunda istatistiksel olarak anlamlı iyileşme bulundu (p<0,05). Gruplar arası fark Paired Sample T test ile değerlendirildiğinde tüm parametrelerde birinci grupta, kontrol grubuna göre istatistiksel olarak anlamlı farklılık bulundu (p<0,05). Gruplar arası yapılan tekrarlı ölçümlerde varyans analizi sonuçlarına göre tedavilerin uzun dönem etkileri karşılaştırıldığında; ağrı, eksternal rotasyon eklem hareket açıklığı, baş üstü uzanma seviyesi ve SPADİ total skorunda birinci grupta istatistiksel olarak anlamlı iyileşme bulundu (p<0,05). Sonuçlar: Bu çalışmanın sonucunda, subskapularis kasına yapılan gevşetmenin, klasik omuz rehabilitasyon uygulamalarına göre ağrı, EHA, disabilite ve fonksiyonel durum üzerine daha etkin olduğu bulundu. Omuz disfonksiyonlarının tedavisinde klasik omuz rehabilitasyon uygulamalarına yumuşak doku mobilizasyonlarının eklenmesi ile tedavinin etkinliğinin artıralabileceği sonucuna varıldı.
Anahtar Kelimeler
fonksiyonellik yumuşak doku mobilizasyonu subskapularis omuz ağrısı
Kaynakça
- 1. van der Heijden GJ. Shoulder disorders: a state-of-the-art review. Baillieres Best Pract Res Clin Rheumatol.1999; 13: 287-309.
- 2. van der Windt DAWM, Koes BW, De Jong BA, Bouter LM. Shoulder dis orders in general practice: incidence, patient characteristics and management. Ann Rheum Dis.1995; 54:95964.
- 3. Godges JJ, Mattson-Bell M, Thorpe D, Shah D. The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. Journal of Orthopaedic and Sports Physical Therapy. 2003; 33(12):713-718.
- 4. Raja SN, Meyer RA, Ringkamp M, Capmbell JN. Peripheral neural mechanisms of nociception. In: Textbook of pain. 4th ed. Edited by Wall PD, Melzack R. Edinburgh, Churchill Livingstone. 1999;11-57.
- 5. Jing-lan Yang, Chein-wei Chang, Shiau-yee Chen, Shwu-Fen Wang, Jiu-jenq Lin. Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial Physical Therapy. 2007; 87(10):1307-1315.
- 6. Functional Soft-Tissue Examination and Treatment by Manual Methods. Third Edition. Edited by Warren I. Hammer, editor. Jones and Bartlett Publishers, Sudbury, Massachusetts, 2007, 775.
- 7. MacDonald PB, Hawkins RJ, Fawler PJ, Miniaci A. Release of the subscapularis for internal rotation contracture and pain after repair for recurrent anterior dislocation of the shoulder. J Bone Joint Surg am. 1992; 74:734-737.
- 8. Michener LA, Walswort M, Burnet E. Effectiveness of rehabilitation for patient with subacromial impingement syndrome:a systematic review. J Hand ther. 2004;17(2):152-164.
- 9. Surenkok O, Aytar A, Baltaci G. Acute effects of scapular mobilization in shoulder dysfunction: a double blind randomized placebo-controlled trial. Journal of Sports Rehabilitation. 2009; 18:493-501.
- 10. Peterson D, Bergmann Chiropractic technique; Principles and procedurs. St.Louis; Mosby: 202.
- 11. Blackburn TA, Boissonnault WG, Bryan JM. Orthopaedic physical therapy. New York; Churchill Livingston: 1989.
- 12. Senbursa G, Baltaci G, Atay A. The effectiveness of manual therapy in supraspinatus tendinopathy. Acta Orthop Traumatol Turc. 2011; 45(3):162-167.
- 13. Jarvinen, T. Jarvinen T.L. Kaarriainen, M. Kalimo, H. Jarvinen, M. Muscle biology; biology and treatment. American Journal of Sports Medicine. 2005; 33(5):745-765.
- 14. Robb A, Pajaczkowski J. Immediate effect on pain threshold using active release technique on adductor strains: pilot study. Journal of Body Work and Movement Therapies. 2011; 15:57-62.
- 15. Myles PS, Troedel S, Boquest M, Reeves M. The pain visual analog scale: is it linear or nonlinear? Anesth Analg. 1999; 89(6):1517-1520.
- 16. Otman AS, Köse N. Basic evaluation methods in treatment movements. Hipokrat Bookstore, 2016, Ankara.
- 17. Hayes K, Walton JR, Szomor ZL, Murrel G. Reliability of five methods for assessing shoulder range of motion. Australian Journal of Physiotherapy. 2001; 47: 289-294.
- 18. Staples M. P, Forbes A, Green S, Buchbinder R. Shoulder‐ specific disability measures showed acceptable construct validity and responsiveness. Journal of Clinical Epidemiology. 2010; 63(2):163–170.
- 19. De Vet HC, Terwee CB, Bouter LM. Current challenges in clinimetrics. J Clin Epidemiol. 2003;56: 1137–1141.
- 20. Al Dajah SB. Soft tissue mobilization and PNF improve range of motion and minimize pain level in shoulder impingement. J. Phys. Ther. Sci. 2014; 26:1803-1805.
- 21. Coviello JP, Kakar RS, Reynolds TJ. Short term effects of instrument-assisted soft tissue mobilization on pain free range of motion in a weightlifter with subacromial pain syndrome. Int J Sports Phys Ther. 2017; 12(1):144-154.
- 22. Analan PD, Leblebici B, Adam M. Effects of therapeutic ultrasound and exercise on pain, function, and isokinetic shoulder rotator strenght of patients with rotator cuff disease. J. Phys. Ther. Sci. 2015; 27: 3113-3117.
- 23. Gürsel Kurtaiş Y, Ulus Y, Bilgiç A, Dinçer G, van der Heijden G. Adding ultrasound in the management of soft tissue disorders of the shoulder: A randomized placebo-controlled trial. Physical therapy. 2004; 84(4):336-343.
THE EFFECTS OF SOFT TISSUE MOBILIZATION APPLIED TO THE SUBSCAPULARIS MUSCLE ON PAIN AND FUNCTIONALITY IN SHOULDER DYSFUNCTIONS
Öz
Purpose: The aim of this study is to appreciate the soft tissue mobilization applied on the subscapularis intended to increase shoulder range of motion, function and decrease the pain will produce improvement on shoulder pathology. Methods: Patients with 48 shoulder pain and limitation were included in the study. They were divided into soft tissue mobilization (STM) group and conventional physiotherapy programme (CPP) group randomly. All patients got treatment at the clinic, including 15 sessions of 25 minutes. The first group received conventional physiotherapy treatment. The second group received soft tissue mobilization. Pain was evaluated with Visual Analog Scale (VAS), shoulder joint movements were evaluated with goniometer, overhead reach test, functionality was evaluated with Shoulder Pain and Disability Index. The cases were evaluated before, immediately after and 3 weeks after the end of treatment. Results: There were statistically significant differences in pain and range of motion results among the groups (p˂0.05). Effect sizes were large for STM group in VAS, external rotation range of motion, over head reach test parameters. However, STM group’s effect size was lower than CPP group in flexion range of motion. Conclusion: Soft tissue mobilization was found to be more effective on pain, range of motion, functionality than classical shoulder rehabilitation.
Anahtar Kelimeler
functionality soft tissue mobilization subscapularis shoulder pain
Kaynakça
- 1. van der Heijden GJ. Shoulder disorders: a state-of-the-art review. Baillieres Best Pract Res Clin Rheumatol.1999; 13: 287-309.
- 2. van der Windt DAWM, Koes BW, De Jong BA, Bouter LM. Shoulder dis orders in general practice: incidence, patient characteristics and management. Ann Rheum Dis.1995; 54:95964.
- 3. Godges JJ, Mattson-Bell M, Thorpe D, Shah D. The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. Journal of Orthopaedic and Sports Physical Therapy. 2003; 33(12):713-718.
- 4. Raja SN, Meyer RA, Ringkamp M, Capmbell JN. Peripheral neural mechanisms of nociception. In: Textbook of pain. 4th ed. Edited by Wall PD, Melzack R. Edinburgh, Churchill Livingstone. 1999;11-57.
- 5. Jing-lan Yang, Chein-wei Chang, Shiau-yee Chen, Shwu-Fen Wang, Jiu-jenq Lin. Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial Physical Therapy. 2007; 87(10):1307-1315.
- 6. Functional Soft-Tissue Examination and Treatment by Manual Methods. Third Edition. Edited by Warren I. Hammer, editor. Jones and Bartlett Publishers, Sudbury, Massachusetts, 2007, 775.
- 7. MacDonald PB, Hawkins RJ, Fawler PJ, Miniaci A. Release of the subscapularis for internal rotation contracture and pain after repair for recurrent anterior dislocation of the shoulder. J Bone Joint Surg am. 1992; 74:734-737.
- 8. Michener LA, Walswort M, Burnet E. Effectiveness of rehabilitation for patient with subacromial impingement syndrome:a systematic review. J Hand ther. 2004;17(2):152-164.
- 9. Surenkok O, Aytar A, Baltaci G. Acute effects of scapular mobilization in shoulder dysfunction: a double blind randomized placebo-controlled trial. Journal of Sports Rehabilitation. 2009; 18:493-501.
- 10. Peterson D, Bergmann Chiropractic technique; Principles and procedurs. St.Louis; Mosby: 202.
- 11. Blackburn TA, Boissonnault WG, Bryan JM. Orthopaedic physical therapy. New York; Churchill Livingston: 1989.
- 12. Senbursa G, Baltaci G, Atay A. The effectiveness of manual therapy in supraspinatus tendinopathy. Acta Orthop Traumatol Turc. 2011; 45(3):162-167.
- 13. Jarvinen, T. Jarvinen T.L. Kaarriainen, M. Kalimo, H. Jarvinen, M. Muscle biology; biology and treatment. American Journal of Sports Medicine. 2005; 33(5):745-765.
- 14. Robb A, Pajaczkowski J. Immediate effect on pain threshold using active release technique on adductor strains: pilot study. Journal of Body Work and Movement Therapies. 2011; 15:57-62.
- 15. Myles PS, Troedel S, Boquest M, Reeves M. The pain visual analog scale: is it linear or nonlinear? Anesth Analg. 1999; 89(6):1517-1520.
- 16. Otman AS, Köse N. Basic evaluation methods in treatment movements. Hipokrat Bookstore, 2016, Ankara.
- 17. Hayes K, Walton JR, Szomor ZL, Murrel G. Reliability of five methods for assessing shoulder range of motion. Australian Journal of Physiotherapy. 2001; 47: 289-294.
- 18. Staples M. P, Forbes A, Green S, Buchbinder R. Shoulder‐ specific disability measures showed acceptable construct validity and responsiveness. Journal of Clinical Epidemiology. 2010; 63(2):163–170.
- 19. De Vet HC, Terwee CB, Bouter LM. Current challenges in clinimetrics. J Clin Epidemiol. 2003;56: 1137–1141.
- 20. Al Dajah SB. Soft tissue mobilization and PNF improve range of motion and minimize pain level in shoulder impingement. J. Phys. Ther. Sci. 2014; 26:1803-1805.
- 21. Coviello JP, Kakar RS, Reynolds TJ. Short term effects of instrument-assisted soft tissue mobilization on pain free range of motion in a weightlifter with subacromial pain syndrome. Int J Sports Phys Ther. 2017; 12(1):144-154.
- 22. Analan PD, Leblebici B, Adam M. Effects of therapeutic ultrasound and exercise on pain, function, and isokinetic shoulder rotator strenght of patients with rotator cuff disease. J. Phys. Ther. Sci. 2015; 27: 3113-3117.
- 23. Gürsel Kurtaiş Y, Ulus Y, Bilgiç A, Dinçer G, van der Heijden G. Adding ultrasound in the management of soft tissue disorders of the shoulder: A randomized placebo-controlled trial. Physical therapy. 2004; 84(4):336-343.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Rehabilitasyon |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Ağustos 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 32 Sayı: 2 |
