This randomized controlled trial aims to evaluate the additional effects of kinetic chain training combined with standard shoulder exercises in patients with Subacromial Pain Syndrome (SAPS). SAPS is one of the most common causes of shoulder pain and is associated with altered scapular mechanics, reduced thoracic mobility, and impaired lumbopelvic stability. Conventional rehabilitation primarily targets the shoulder joint and local musculature, often overlooking the contribution of the kinetic chain. This study wil investigate whether integrating kinetic chain training into standard rehabilitation provides superior clinical outcomes.A single-blinded, parallel-group randomized controlled trial will be conducted involving 46 participants aged 35-60 years diagnosed with unilateral SAPS. Participants will be recruited through purposive sampling and randomly allocated into either a control group receiving standard shoulder rehabilitation or an experimental group receiving standard rehabilitation plus kinetic chain training for six weeks. The kinetic chain intervention includes lower trapezius strengthening, thoracic spine and rib mobilization, longissimus and multifidus activation, and gluteus maximus strengthening.
Primary outcomes will include pain intensity, shoulder range of motion, functional disability, scapular dyskinesis, and shoulder muscle strength. These will be assessed using the Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), universal goniometer, bubble inclinometer, and handheld dynamometer before and after the intervention. The findings of this study are expected to determine whether a biomechanically integrated rehabilitation approach offers greater improvements than conventional shoulder-focused exercises alone, thereby providing evidence to guide physiotherapy management of SAPS.
Age between 35-60 years
Both Gender
Unilateral shoulder pain consistent with SAPS.
pain during activities with abduction, external rotation and overhead activities
Age below 35 years or above 60 years
History or clinical signs of complete supraspinatus or long-head biceps tendon tear
History of fracture or dislocation of the shoulder, history of surgery around the shoulder with in last year
Restrictions in passive movements of the GH joint (adhesive capsulitis)
Parallel
Group A (Standard shoulder exercises)
Procedure/SurgeryParticipants in the control group will receive a standardized six-week shoulder rehabilitation program consisting of education and activity modification, pain-free range of motion exercises, isolated rotator cuff strengthening, stretching of tight muscles, and scapular muscle activation. Education will focus on avoiding aggravating overhead activities while encouraging use of the affected arm within pain-free limits. Range of motion exercises will include Codman pendulum exercises and active-assisted shoulder abduction and external rotation. Isometric strengthening will target shoulder external rotation and abduction, with progressive repetitions and hold durations. Stretching will include the pectoralis minor and upper trapezius. Scapular muscle activation will be performed using the Dynamic Hug (Plus) exercise with theraband resistance. Exercise dosage will be progressively increased over the six-week intervention according to participant tolerance and symptom response.
Group B (Kinetic chain training)
Procedure/SurgeryParticipants will receive the same six-week standard shoulder rehabilitation program as the control group, supplemented with kinetic chain training. The kinetic chain protocol will include four components: progressive lower trapezius strengthening, thoracic spine and rib mobilization, longissimus and multifidus activation, and gluteus maximus strengthening. Lower trapezius strengthening will progress from supported scapular depression and retraction to modified and full prone cobra exercises. Thoracic mobilization will include central posterior-anterior mobilization and costotransverse unilateral posterior-anterior glides targeting the upper to mid-thoracic ribs (levels 1-6). Longissimus and multifidus activation will be performed through progressive bird-dog exercises. Gluteus maximus strengthening will involve progressive bilateral and unilateral bridging exercises. All exercises will be progressed over six weeks according to participant tolerance.
Shoulder Pain
Measured using Numeric Pain Rating Scale (0-10), Eligibility cut-off of Numeric Pain Rating Scale is 4-7 at baseline.
Shoulder abduction range of motion
Active shoulder abduction ROM will be measured in sitting using a universal goniometer
Shoulder external rotation range of motion
External rotation ROM will be measured in supine with the shoulder at 90° abduction and elbow at 90° flexion using a universal goniometer.
Functional disability
Measured using the Shoulder Pain and Disability Index, consisting of 13 items assessing shoulder pain and functional limitations.
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