for physiotherapist

1. PROJECT GUIDE NAME: DR. RAJA LAXMI
G.SPERJAN
REG NO:112121103024
BPT IV YEAR
TO COMPARE THE EFFECTIVENESS
OF KINESIO TAPING AND EXERCISE
IN PATIENTS WITH SHOULDER
IMPINGMENT SYNDROME

2. INTRODUCTION
 shoulder problems in general medical practice is estimated to
be 1 1.2/ 1000 patients per year. Lifetime prevalence of
shoulder pain has been reported to range from 7% to 36% of
the population.
 Shoulder impingement has been defined as compression and
mechanical abrasion of rotator cuff structures as they pass
beneath the coracoacromial arch during arm elevation.
 It is the most common disorder of shoulder with prevalence
ranging from 44% to 65%. The vast majority of people with
impingement syndrome who are younger than 60 years of age
relate their symptoms to occupational or athletic activities that
involve frequent overuse of arm.


3.  Impingement is caused due to inadequate space for
clearance of rotator cuff tendons as arm is elevated. It is
classified into primary shoulder impingement and
secondary shoulder impingement.

 Primary shoulder impingement is due to the intrinsic
factors such as rotator cuff weakness, chronic
inflammation of rotator cuff tendon or sub acromial
bursa, posterior capsule tightness which leads to
superior and anterior translation of humeral head. It is
also may be due to extrinsic factors like hooked
acromion, acromial spurs or postural dysfunction.


4. The secondary impingement is defined as relative
decrease in the sub acromial space which is caused
due to glenohumeral joint instability.
The supraspinatus along with other rotator cuff
muscles serve to maintain the congruence between
the humeral head and glenoid fossa by producing
compressive force during glenohumeral movements.
Abnormal superior, anterior translations have been
linked to fatigue of rotator cuff and tightness of
posterior capsule. Dysfunctional and weak rotator cuff
musculature have been documented in patients with
shoulder impingement.

5. history of kinesio taping kinesio taping is a modality
treatment based on the body's own natural healing
process.
the kinesio taping method exhibits its efficacy through
the activation of the neurological and circulatory
systems. this method basically stems from the science
of kinesiology, recognizing the importance of body and
muscle movement in rehabilitation and everyday life.
hence the name

6. the kinesio taping method exhibits its efficacy through
the activation of the neurological and circulatory
systems. this method basically stems from the
science of kinesiology, recognizing the importance of
body and muscle movement in rehabilitation and
everyday life. hence the name "kinesio" is used.
muscles attribute not only to the movement of the
body, but also control the circulation of venous and
lymph flows, body temperature, etc.
using an elastic tape, it was discovered that muscles
and other tissues could be helped by outside
assistance.

7. soon there after kinesio taping vas discovered by
olympic volleyball players for preventative
maintenance in japan and word quickly spread to
other athlets. today, kinesio taping is accepted by
medical practitioners and athlets in japan. the united
states, europe, south america, australia and other
asian countries as well.
There are various studies done on the effect of
normal scapular taping and also on the effect of
mobilization with movement with scapular stabilizing
exercises in shoulder impingement which have been
proved to be an effective treatment in reducing pain
and improving ROM.

8. Kinesiotaping is said to be an advanced treatment
technique which has been considered in reducing
pain, improving muscle function and joint
proprioception.
There are very few studies conducted on the effect of
kinesiotaping in shoulder impingement along with
mobilization with movement technique.
Therefore there is a need to study the effectiveness of
mobilization with movement and kinesiotaping in
improving the shoulder ROM, functional status and
reducing pain in patients with shoulder impingement.

9. A visual analogue scale (vas) is a measurement
instrument that tries to Measure a characteristic or
attitude that is believed to range across a Continue of
values and cannot easily be directly measured.
The disabilities of the arm shoulder and hand (dash)
symptom scale can Be used to evaluate a patient
with a disorder of the upper extremity. it Can be used
to monitor the patient over time and to determine the
Effectiveness of an intervention.

10. The dash consists mainly o f a 3 0-item
disability/symptom scale.
we Per formed cross cultural adaptation of the
dash to swedish, using A process that included
double forward and backward translations, Expert
and lay review, as well as field -testing to achieve
linguisti
And conceptual equivalence. the swedish Version
reliability and validity were then evaluated.

11. REVIEW OF LITERATURE
HELEN H HOST (1995) Conducted a study to find out
the effectiveness of scapular taping in the treatment of
anterior shoulder impingement. The purpose of this
case report is to describe how taping designed to
promote proximal scapular stability was used in
conjunction with other physical therapy interventions to
manage a patient with anterior shoulder impingement.
This case report demonstrates that a patient was able
to return to all of his regular overhead sports activities
without pain following scapular taping used in
combination with a home exercise program.

12. c. The term subacromial impingement was introduced
by NEER, and refers to compression of rotator cuff,
sub acromial bursa to biceps tendon against the
anterior under surface of the acromian and
coracoacromial ligament, especially during elevation
of the arm.
VAN-DER WINDT (1995). The believe shoulder
impingement are the most common cause of shoulder
pain, and there is general consequences that
impingement is the primary underlying problem or at
least a migrating factor in many rotator cuff disorder.
NEER estimated that 95% of rotator cuff tears are due
to impingement.

13. AIMIE F. KACHINGWE et al (2008) Main outcome
measures included 24-hour pain (VAS), pain with the
Neer and Hawkins-Kennedy tests, shoulder active
range of motion (AROM), and shoulder function
(DASH). exercise program may result in a greater
decrease in pain and improved function in patients
with shoulder impingement .
MARK D THELEeN t al(2008) State that Self-
reported pain and disability and pain-free active range
of motion (ROM) were measured at multiple intervals
to assess for differences between groups. Results
showed that therapeutic kinesio tape showed
immediate improvement in pain free shoulder
abduction after tape application.

14. BOONSTRA et al (2008) such that Conducted a
study to determine the reliability and concurrent
validity of a visual analogue scale (VAS) for disability
as a single-item instrument measurement. For the
reliability study a test-retest design and for the validity
study a cross-sectional design was used.
DESAI AS, DRAMIS A et al (2010) such that
Conducted a study on critical appraisal of subjective
outcome The DASH has shown to have good
construct validity, excellent test-re-test reliability and
responsiveness to change ome measures used in the
assessment of shoulder disability. Five common
shoulder patient-based scores were identified:
disability of arm, shoulder and hand (DASH)

15. ALQUNAEE M et al (2012) Conducted a study to
examine the accuracy of clinical tests for diagnosing
subacromial impingement syndrome (SIS). They
concluded that The Hawkins-Kennedy test, Neer's
sign, and empty can test are shown to be more useful
for ruling out rather than ruling in shoulder
impingement syndrome.

16. DESANTIS, LUCY; HASSON, SCOTT (2006) Conducted a
study of supraspinatus tendinopathy secondary to
impingement. Outcome measures used included goniometric
active range of motion (AROM) measurements and manual
muscle tests of the shoulder, impingement tests, and the
Shoulder Pain and Disability Index .This case report indicates
that may be an effective treatment intervention for patients with
subacromial impingement.
Dr. Kenzo Kase The method originated in Japan in 1973
and over the years it has stretched its horizons to many
countries worldwide. History of Kinesio Taping Kinesio Taping is
a modality treatment based on the body's own natural healing
process.

17. ALQUNAEE M et al (2012) Conducted a study to
examine the accuracy of clinical tests for diagnosing
subacromial impingement syndrome . They
concluded that The Hawkins-Kennedy test, Neer's
sign, and empty can test are shown to be more useful
for ruling out rather than ruling in shoulder
impingement syndrome.
GRAICHEN H, BONEL (1999)
Suggesting that exercise in individuals with common
postural deficits alter alters scapulohumeral rhythm.

18. HARRYMAN H,BONEL (1990). Patient with
impingement shows greater deficits alter Under loaded.
CELIK D, ET AL (2009)
Did a study on comparison of the effects of two different
Exercise programs on pain in subacromial impingment
syndrome and concluded that the exercise program below 90
degrees (pain- free range of motion) resulted in additional
improvement in vas scale.
JCLINNURSE,et al (2005) Did a study on pain : a review
of pain rating scales and concluded that pain rating scale are
valid, reliable and appropriate for use in clinical practice.

19. KUHN F, et al(2000) Did a study on exercise
in the treatment of rotator cuff impingement and
concluded that the data demonstrate that exercise
has statistically and clinically significant effects on
pain reduction and improving function.
BONICA.JJ- VAS is quick and accurate
scale by which paient rate heir
pain.

20. MILLIS SR -2001 The vas is usefull as a screening
measure to assist the clinician is quickly identifying problem in
the doctor patient relationship. Patient who are unable to
complete standard questionnaires also can use the VAS.
SKUTEK,M.R.W.FREMERECY.et al He concluded
dash scale useful as a screening measure to assist the clinician
in quickly identifying problems and early effectiveness achieved
by using shoulder assessment scale.(DASH)
Thelen et al . ,(2008) Kinesio taping (KT) is becoming
increasingly popular. Taping techniques aimed at improving
circulation, pain, muscle activation, proprioception, and
function.

21. Kase et al., (2003) KT is elastic and can be stretched
Up to 55=60% of its length Allows unrestricted movement.
Stupik et al., (2007) Research is conflicting about
whether or not kinesio taping can increase muscle activation.
Mac Gregor et al., (2005) Taping could stimulate
cutaneous mechanoreceptors and Deliver more signals to the
CNS.
Chen et al., (2008) Kinesio tape can lift the skin to
increase space between skin And muscle, reducing the
localized pressure, promoting Circulation and lymphatic
drainage This theoretically reduces pain, swelling, and muscle
spasm.

22. Halseth T (2004) KT can be applied to virtually any
muscle or joint in the body. However, minimal evidence exists
to support the use of this type of tape in the treatment of
musculoskeletal disorders.
Green S (2003) Life time prevalence of shoulder pain has
been reported to range from 7% to 36% of the population.
Matsen FA, Arntz CT (1990)
Shoulder impingement has been defined as compression and
mechanical abrasion of the rotator cuff structures as they pass
beneath the coracoacromial arch during elevation of the arm

23. Whitney SL (1993) Multiple theories have been
proposed to explain the primary etiology of shoulder
impingement, including anatomic abnormalities of the
coracoacromial arch or humeral head, “tension
overload ,”ischemia, or degeneration of the rotator cuff
tendons; and shoulder kinematic abnormalities

24. Thank you