An interventional study of Group A will perform the prone row exercise and selected physical therapy treatment and Group B will receive selected physical therapy treatment and Lateral pull down exercise. in Shoulder Impingement Syndrome and Scapular Dyskinesis, sponsored by Cairo University. Not yet recruiting at 1 site in Egypt. Open to participants aged 40 Years to 65 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-05-13.
Sponsored by Cairo University · Not applicable, Interventional, and Treatment
The purpose of this study is to compare the prone row exercise, and the lateral pull down exercise, in individuals diagnosed with shoulder impingement syndrome and scapular dyskinesia regarding latissimus dorsi strength, middle trapezius strength, lower trapezius strength, rhomboids strength, Visual analog scale score, Shoulder pain and disability index score and scapular stability test values.
Shoulder impingement syndrome (SIS) is a common musculoskeletal disorder, accounting for approximately 44-65% of all shoulder pain complaints. Normal scapular stability includes the ability to keep the scapula's normal position while the arms are at your sides and throughout all upper-limb movements . The upper, middle, and lower trapezius muscles couple with the serratus anterior and rhomboid muscles to form "force couples," which are thought to be important for appropriate scapular orientation.
Scapular dyskinesis occurs when the scapular stabilizing muscles (upper, middle, and lower trapezius, serratus anterior, and latissimus dorsi) are unable to preserve typical scapular movement, and is considered potentially harmful when it results in increased anterior tilting, downward rotation, and protraction, all of which reorient the acromion to reduce the subacromial space width.
Bilateral prone rowing has demonstrated clear clinical benefits for patients with subacromial impingement syndrome. In a four week, supervised program where 16 individuals with stage II SIS performed low rowing three times per week, The Lateral Pull down exercise is widely recognized for its activation of the latissimus dorsi, but it also significantly recruits scapular stabilizers such as the lower trapezius and rhomboids, especially when performed with proper scapular depression and retraction. This makes it an effective exercise for improving scapular muscle strength and control in both healthy individuals and those undergoing shoulder rehabilitation .
Fifty-four male and female patients, with age between 40-65 years (mean age of 52.5 ± 6.25 years) (Yilmaz et al., 2023), will be recruited through direct referrals from orthopedic doctors. They will be asked to sign the informed consent form.
The study will employ a two experimental group protocol. Each group will follow a distinct exercise intervention. Group A will perform the prone row exercise, while Group B will engage in the lateral pull-down exercise. Both groups will also receive selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises . The intervention period will last for 6 weeks, with sessions conducted three times per week under physiotherapist supervision.
Outcome measures:
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Exclusion Criteria:
Prone rowing and selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises (Dabholkar \& Yardi 2015).
Procedure: Group A will perform the prone row exercise and selected physical therapy treatment
Lateral Pull Down exercise and selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises
Procedure: Group B will receive selected physical therapy treatment and Lateral pull down exercise.
prone row exercise: freely off the side and the head in a neutral position, supported if needed. The starting position involves 90-degree shoulder flexion with full elbow extension (0-degree elbow flexion), transitioning into 0-degree shoulder flexion with 90-degree elbow flexion. From this position, a bilateral vertical pulling movement is performed, involving scapular retraction and shoulder extension against resistance. The motion ends with the elbow flexed at 90 degrees, the shoulder extended, and the scapula fully retracted towards the spine, with control throughout the movement. selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises
The patient is seated on the pulldown machine with an upright trunk and feet flat on the floor, maintaining a stable posture. The starting position includes gripping the straight bar with a wide overhand (pronated) grip, marked to ensure a between-hands distance equal to 1.6 times the biacromial distance which is the horizontal distance between the most lateral points of the right and left acromion processes (shoulder tip). From this position, the participant performs a downward pulling movement, bringing the bar down in front of the face toward the upper chest near the clavicle in a smooth and controlled manner. selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises
Lateral scapular slide test
Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Odom, 2001; Kibler, 1998).
Time frame: (pre-intervention) and after 6 weeks (post-intervention)
Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using Handheld dynamometer (HHD)
Lafayette HHD revealed mostly good to excellent reliability (coefficients ≥ 0.70) for all LL muscles measurements. Also, it has good validity for most measures of isometric LL strength and power in healthy population. Lafayette HHD is a reliable instrument to measure the foot and ankle strength of young and older adults, for both intra-rater (ICC (3,1) = 0.78-0.94) and interrater (ICC (3,1) = 0.77-0.88) comparisons. (Celik et al., 2012).
Time frame: (pre-intervention) and after 6 weeks (post-intervention)
Pain using the Visual Analogue Scale (VAS)
The Visual Analogue Scale (VAS) will be used to measure pain. The VAS is a straight line, with one end representing 0 (no pain) and the other end representing 10 (worst pain possible). The number 0 indicates no problem, and 10 represents the worst possible condition (Huskisson, 1974).
Time frame: (pre-intervention) and after 6 weeks (post-intervention)
Function using SPADI
Shoulder pain and disability index (SPADI) is demonstrated to be a validated and reliable measure of shoulder pain and disability (Roach et al., 1991). The translated version of SPADI in the Arabic language showed excellent internal consistency and test-retest reliability and construct validity based on substantial correlations of Arabic SPADI with Quick DASH, NRS, and active shoulder ROM. SPADI is recommended for the evaluation of patients with shoulder dysfunction (Alsanawi et al.,2015)
Time frame: (pre-intervention) and after 6 weeks (post-intervention)
Plan to share: No — sensitive patient data.
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Cairo University