Diaphragm Mobilization With Rotator Cuff Lesions

Summary

The glenohumeral joint is the least restricted joint in terms of mobility compared to other joints in the human body. The rotator cuff is a part of the shoulder complex consisting of four muscles and their tendons, which are responsible for stabilizing the shoulder joint. These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. The supraspinatus muscle enables shoulder abduction, infraspinatus and teres minor provide external rotation, and the subscapularis is responsible for internal rotation.

The presence of a rotator cuff lesion is the most common cause of shoulder pain. It usually results from the tear, inflammation, or injury of one or more rotator cuff muscles. It is more prevalent in elderly individuals and is characterized by severe shoulder pain, limited range of motion, and functional loss. These symptoms negatively impact the patient's performance and significantly reduce their quality of life.

The diaphragm is a large, dome-shaped muscle and the primary muscle of respiration. It is innervated by the phrenic nerve, which is connected to the vagus nerve. During breathing, the diaphragm's movements can directly or indirectly influence the sympathetic and parasympathetic nervous systems, thereby modulating pain perception in the body.

Moreover, there is a significant relationship between the shoulder and diaphragm in terms of myofascial connections and neural innervation. Effective functioning of the diaphragm not only contributes to proper respiration but also positively affects spinal mobility and overall posture. It supports the efficiency of upper body structures such as the cervical spine, shoulder, and neck.

Proper diaphragmatic function contributes to core stability, which in turn may reduce the load on shoulder structures. Manual techniques targeting the diaphragm can enhance its function, potentially reducing the mechanical load on the shoulder complex, alleviating pain, and improving the patient's overall functional capacity.

Conditions

• Rotator Cuff Syndrome

Interventions

OTHER

Diaphragm mobilization

This group underwent treatment three times a week, with each session lasting 40 to 60 minutes, over a period of six weeks. Diaphragm mobilization included techniques aimed at increasing muscle elasticity, improving postural balance, and reducing pain by stimulating the sympathetic and parasympathetic nervous systems. In each session, participants received 20 minutes of TENS and 10 minutes of cryotherapy. Following this, diaphragm mobilization was applied. During the application, participants were positioned comfortably in the supine position. The physiotherapist palpated the diaphragm, instructed the participant in diaphragmatic breathing, and asked them to take a deep diaphragmatic breath. During expiration, the diaphragm was mobilized in the posterior and inferior directions. This mobilization was performed 10 times per session. Following that, posterior glide and inferior glide techniques were performed.

OTHER

conventional physical therapy

As with the experimental group, therapy will be delivered three times per week for six weeks, with each session lasting between 40 and 60 minutes. Each session will include 20 minutes of TENS and 10 minutes of cryotherapy, followed by posterior and inferior gliding techniques on the glenohumeral joint and capsular stretching. Functional exercises will also include wand exercises (two sets of 10 repetitions) and finger ladder exercises targeting shoulder flexion and abduction, but without the addition of diaphragm mobilization techniques.

Sponsors & Collaborators

• Uskudar University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

25 Years

Max Age

55 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-03-01

Primary Completion

2025-05-30

Completion

2025-06-30

Countries

• Turkey (Türkiye)

Study Locations