Timas Peteraitis1, Fred Smedes2. 1. Department of Physical Therapy, Saxion, University of Applied Sciences, Enschede, the Netherlands. 2. Department of Physical Therapy, Saxion, University of Applied Sciences, Enschede, the Netherlands; Practice for Physical Therapy: "Beumer", Losser, the Netherlands. Electronic address: f.smedes@saxion.nl.
Abstract
INTRODUCTION: Shoulder complaints have high re-occurrence rates and scapular control seems to be a major influencing factor in sub-acromial impingement syndromes (SIS). Scapular dyskinesia disrupts the scapulohumeral rhythm, altering biomechanical loads on the rotator cuff in shoulder movements. As a result, this disturbs the natural healing process. Proprioceptive Neuromuscular Facilitation (PNF) seems to be a promising treatment approach because it has a focus on motor learning. This case report seeks to illustrate the clinical reasoning and feasibility of applying the comprehensive nature of PNF in a patient who was not responsive to standard physiotherapy. CASE DESCRIPTION: A 47-year-old male, a former professional handball player, was diagnosed with a SIS based upon a rotator-cuff tendinopathy, scapular dyskinesia and degeneration of supraspinatus tendon. The patient presented complaints of right sided shoulder pain in overhead activities and in reaching behind the back. PATIENT MANAGEMENT: PNF-based motor-control training was provided over a period of five weeks. This approach included specified PNF-pattern exercises with specific PNF-facilitation principles and techniques. The results were improvements beyond the minimal clinical important difference and/or minimal detectable change for physical functioning, pain, range of motion, and functional disability of the shoulder. DISCUSSION AND CONCLUSION: PNF provided an opportunity for motor control training, restored altered movement patterns in the patient's daily life activities. The approach addressed motor learning effects and structural impairments. PNF-patterns have been described as: "mimicking functional activities" from daily life and from sports. In cases where standard strengthening and mobilization exercises are not effective, a specified PNF-based therapy has shown to be a feasible alternative.
INTRODUCTION: Shoulder complaints have high re-occurrence rates and scapular control seems to be a major influencing factor in sub-acromial impingement syndromes (SIS). Scapular dyskinesia disrupts the scapulohumeral rhythm, altering biomechanical loads on the rotator cuff in shoulder movements. As a result, this disturbs the natural healing process. Proprioceptive Neuromuscular Facilitation (PNF) seems to be a promising treatment approach because it has a focus on motor learning. This case report seeks to illustrate the clinical reasoning and feasibility of applying the comprehensive nature of PNF in a patient who was not responsive to standard physiotherapy. CASE DESCRIPTION: A 47-year-old male, a former professional handball player, was diagnosed with a SIS based upon a rotator-cuff tendinopathy, scapular dyskinesia and degeneration of supraspinatus tendon. The patient presented complaints of right sided shoulder pain in overhead activities and in reaching behind the back. PATIENT MANAGEMENT: PNF-based motor-control training was provided over a period of five weeks. This approach included specified PNF-pattern exercises with specific PNF-facilitation principles and techniques. The results were improvements beyond the minimal clinical important difference and/or minimal detectable change for physical functioning, pain, range of motion, and functional disability of the shoulder. DISCUSSION AND CONCLUSION: PNF provided an opportunity for motor control training, restored altered movement patterns in the patient's daily life activities. The approach addressed motor learning effects and structural impairments. PNF-patterns have been described as: "mimicking functional activities" from daily life and from sports. In cases where standard strengthening and mobilization exercises are not effective, a specified PNF-based therapy has shown to be a feasible alternative.