Proprioceptive Neuromuscular Facilitation Techniques versus Closed Kinematic Chain Exercises in Scapular Dyskinesia among Hospital Housekeeping Staff: An Experimental Study

Abstract

Introduction: Housekeeping staff in the hospitals perform various overhead upper extremity motions. These repeatedly performed movements in turn place high physical load on the shoulder joint causing weakness of the scapulothoracic muscles which in turn may lead to scapular dyskinesia. Scapular Dyskinesia is the alteration in normal position or motions of the scapula during arm movement. Proprioceptive neuromuscular facilitation techniques apply neuro-physiological principles to the sensory and motor system to treat various neuro-musculoskeletal dysfunctions. Aim: To evaluate the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) techniques versus Closed Kinematic Chain (CKC) exercises on pain, scapula position and upper extremity work related musculoskeletal disorders in housekeeping staff with scapular dyskinesia. Materials and Methods: This single blinded experimental study, in which participants were blinded to the treatment allocated was conducted between June 2019 to January 2020, at Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Thirty housekeeping staff with scapular dyskinesia, suffering from neck or/and shoulder pain, and aged 18-40 years were randomly assigned to one of the two groups-group A (PNF) or group B (CKC). Both groups received intervention for five days per week for four weeks. Outcome measures were the Numeric Pain Rating Scale (NPRS), Lateral Scapula Slide Test (LSST), Extended Nordic Musculoskeletal Questionnaire (ENMQ) which was assessed pretreatment at 2nd and 4th week of intervention. Data was analysed in PRIMER of biostatistics version 7.0 statistical software. The Friedman Test was used for intra group comparison whereas the Mann-Whitney Rank Sum Test was utilised for intergroup comparison of the results. The statistical difference significance was set at p-value <0.05 for all the tests performed. Results: The mean age of participants in group A and group B were 35.14±4.73 and 33.08±4.51 years, respectively. All the outcome measures on intragroup analysis showed significant improvements. Intergroup comparison revealed no statistical significant difference in the scores of NPRS on rest and activity between both the groups. The LSST for right side of position 3 (p-value=0.04) and of position 1 (p-value=0.02), 3(p-value=0.002) on the left side, showed stastically significant difference between both groups. There was also greater improvement in the scores of ENMQ in the participants of group A receiving PNF compared to group B which received CKC Exercises. Conclusion: The present study proved that both PNF techniques and CKC exercises show significant improvement on pain intensity, increase in the scapular muscle strength and reduction in the upper extremity work related musculoskeletal disorders. However, when compared (LSST and ENMQ), PNF techniques showed statistically greater improvement than CKC exercises.

Keywords

• extended nordic musculoskeletal questionnaire
• lateral scapula slide test
• scapular muscle weakness