Final

“EFFECT OF MUSCLE ENERGY TECHNIQUE ON PAIN,
RANGE OF MOTION, STRENGTH AND FUNCTIONALITY IN

SCAPULAR DYSKINESIS: A RANDOMIZED CONTROLLED
TRIAL”
BY
DR. SIDDHI VINOD PARAB
Dissertation submitted to
PRAVARA INSTITUTE OF MEDICAL SCIENCES
(DEEMED TO BE UNIVERSITY)
Loni, Dist. Ahmednagar, Maharashtra, India :413736.
In partial fulfilment of the

DEGREE OF MASTER OF PHYSIOTHERAPY
Specialization in
MUSCULOSKELETAL SCIENCES
UNDER THE GUIDANCE OF

DR. NEERAJ KUMAR
Dr. A. P. J. ABDUL KALAM COLLEGE OF PHYSIOTHERAPY,

PRAVARA INSTITUTE OF MEDICAL SCIENCES
(DEEMED TO BE UNIVERSITY)
i
2022-2024
DECLARATION BY CANDIDATE
I hereby declare that this dissertation entitled “EFFECT OF MUSCLE

ENERGY TECHNIQUE ON PAIN, RANGE OF MOTION, STRENGTH AND
FUNCTIONALITY IN SCAPULAR DYSKINESIS: A RANDOMIZED
CONTROL TRIAL” is a bonafide and genuine research work carried out by me
under the guidance of Dr. Neeraj Kumar, Vice Principal, HOD of Musculoskeletal
sciences, Dr. APJ Abdul Kalam College Of Physiotherapy , Pravara Institute of
Medical Sciences Loni.(DU).The topic is approved by the Pravara Institute of
Medical Sciences (DU) vide letter Ref No. PIMS/DR.APJAKCOPT/IEC/2023/168
on 21th February 2023.
Date: Signature of the candidate

Place: Dr. Siddhi Vinod Parab
ii
CERTIFICATE OF THE GUIDE
I hereby declare that this dissertation “EFFECT OF MUSCLE ENERGY

TECHNIQUE ON PAIN, RANGE OF MOTION, STRENGTH AND
CONTROL TRIAL” is a bonafide and genuine research work carried out by Dr.
Siddhi Vinod Parab in partial fulfilment of the requirement the Degree of Master of
Physiotherapy specialization of Musculoskeletal Sciences.
Date: Signature of the guide

Place: Dr. Neeraj Kumar
iii
ENDORSEMENT BY H.O.D AND HEAD OF INSTITUTE
I hereby declare that this dissertation entitled “EFFECT OF MUSCLE

ENERGY TECHNIQUE ON PAIN, RANGE OF MOTION, STRENGTH AND
CONTROL TRIAL” is a bonafide and genuine research work carried out by Dr.
Siddhi Vinod Parab in partial fulfilment of the requirement Degree of Master of
Physiotherapy specialization of Musculoskeletal Sciences. Under the guidance of Dr.
Neeraj Kumar, Vice Principal, HOD of Musculoskeletal sciences, Dr. APJ Abdul
Kalam College of Physiotherapy, Pravara Institute of Medical Sciences Loni. (DU)
Seal and Signature of H.O.D Name of Seal and Signature of H.O.I Name of
H.O.D H.O.I
Date: Date:
Place: Place:
iv
ACKNOWLEDGEMENT
Indeed, I am very glad to present this project as part of my M.P.T in
MUSCULOSKELETAL SCIENCES. I take this opportunity to thank all the hands that
have joined together to make this project a success.
It is indeed my privilege to express my sincere gratitude to Dr. Rakesh Sinha
Principal, College of Physiotherapy, Loni for his valuable advice and permitting me
to carry out the project in this institution.
I wish to express my deep gratitude to my project in charge Dr. Neeraj
Kumar and all the teaching staff who have helped me to choose this project and
provide me with constant guidance and support throughout the completion of this
project.
I wish to thank all the participants for their cooperation and tolerance
towards this project.
I would like to bow down to The Almighty and my parents whose blessings,
love and encouragement have always been a catalyst in all walks of my life.
Last but not the least I express my special thanks to all my friends for their
unconditional help and support. They are an essential part of my project.
… Siddhi Vinod Parab
v
CONTENTS
CHAPTER NAME OF TOPIC PAGE NO.

No.
1 INTRODUCTION 1
2 REVIEW OF LITERATURE 7
3 MATERIAL AND METHODOLOGY 13
4 DATA ANALYSIS AND INTERPRETATION 22
5 DISCUSSION 35
6 REFERENCES 41
7 APPENDIX 45
A - Ethical Clearance Letter 45
B - Clinical Trial Registry of India 46
C - Informed Consent 47
D - Constant score 49
E - Plagiarism 50
F - Master Chart 51
vi
LIST OF TABLES
Table Title Page No.

No.
1 Age, Gender wise distribution in participants of both 23
groups
2 Showing Demographic Data Analysis 24
3 Baseline values of all outcome’s measures of both 25
groups
4 Comparison of means of pre and post values of both 27
groups (VAS)
5 Comparison of Control group means of pre and post 28
values of both groups (Range of Motion)
6 Comparison of Experimental group means of pre 29
and post values of both groups (Range of Motion)
7 Comparison of means of pre and post values of both 32
groups (Constant Murley Scale)
8 Comparison of mean of post score of VAS 33
9 Comparison of mean of post score of Range of 34
Motion
10 Comparison of mean of post score of Constant Score 35
vii
LIST OF GRAPHS
Graph Title Page No.

No.
1 Gender-wise distribution in both groups 23
2 Graph Showing Baseline Demographic Data 24
Analysis
3 Baseline score of VAS in both groups 25
4 Baseline score of Range of Motion in both groups 26
5 Baseline score of CMS in both groups 26
6 Within group comparison of Visual Analogue Scale 27
7 Within group comparison of Range of Motion 29
(Flexion)
(Abduction)
(Internal Rotation)
(External Rotation)
11 Within group comparison of Constant Murley Scale 32
12 Between the group comparison of VAS 33
13 Between the group comparison of Range of Motion 34
14 Between the group comparison of Constant Score 35
viii
LIST OF FIGURES
Figure Title Page No.

No.
1.1 Clinical presentation of Scapular Dyskinesis 2
1.2 Showing the types of Scapular Dyskinesia 4
3.1 CONSORT Flow chart representing procedure of 19
selection of participants.
3.2 MET for Trapezius 20
3.3 MET for Pectoralis Minor 20
3.4 MET for Pectoralis Major 21
3.5 MET for Levator Scapulae 21
3.6 MET for Subscapularis 22
3.7 MET for Infraspinatus 22
ix
ABSTRACT
Title: “Effect of Muscle Energy Technique on pain, range of motion, strength, and
functionality in scapular dyskinesis - A Randomized Controlled Trial”
Background: Scapula kinematics is appropriate provide for the best possible function of the
shoulder joint, including the ability to do repetitive hand over head movements. Scapular
dyskinesis describes a loss of control over normal scapular mechanics, physiology, and
motion. Because of its functions in scapulohumeral rhythm and its correlation with a wide
range of clinical shoulder ailments, the scapula has been highlighted as a critical component
of efficient shoulder and arm function. Muscle energy technique is a manual therapy
approach involves increase in the muscle length thereby promoting mobility in the joint.
There are various studies, which proves that physiotherapy helps in managing pain,
increasing the strength, Range of Motion and improvement in functional activities. There are
many approaches to treat scapular dyskinesis along with conventional physiotherapy.
Objective: The purpose of the study is to see the effect of Muscle Energy Technique on Pain,
Range of Motion, Strength and Functionality in scapular dyskinesis. Subjects and Method:
Participants were randomly allocated to 2 groups that is experimental group(n=26) and the
conventional group(n=26). Prior assessment of the participants was done. Group A that is the
control group was received conventional physiotherapy treatment and Group B was received
Muscle Energy Technique for scapular muscle and conventional treatment for scapular
dyskinesis. Treatment for Group A was received conventional therapy for 3 times for a week
for 8 weeks Group B. Muscle Energy Technique which was given passively by therapist 3
times a week for 8 weeks Muscle groups such as trapezius, Pectoralis minor, major, levator
scapulae subscapularis and infraspinatus. Analysis of data was done using the IBM SPSS
Software Window V.28.0.1.0 version Descriptive statistics for all outcomes measures
expressed as means, standard deviations and test significance. Therefore, a parametric test
(paired t-test) was used with the Confidence Interval set as 95%. Paired t-test was used to
compare the difference between the pre and post-intervention values on different parameters.
Result: Both the groups showed significant difference in physical and physiological variables
when analyzed at Week 0 and Week 8. The results of the physical variables and
physiological variables showed significant difference with (p <0.0001). Moreover, the mean
differences showed highly significant in Experimental Group. Conclusion: The present
study concludes that the Muscle Energy Technique combined with Conventional
Physiotherapy is more effective than Conventional Physiotherapy alone in improving pain,
ROM, strength, and functionality in scapular dyskinesis.
x
Introduction
CHAPTER 1
INTRODUCTION
The acromioclavicular and sternoclavicular joints, located on the clavicle,

serve to connect the scapula to the axial skeleton, providing crucial structural support
and facilitating a wide range of movement. Anchoring the clavicle to the posterior
section of the ribcage are the serratus anterior, rhomboids, and trapezius muscles,
which play essential roles in stabilizing and controlling the shoulder girdle. This
intricate interplay between bones and muscles optimizes core strength transmission
from the glenohumeral joint to the arm and hand, ensuring efficient and coordinated
movements. Given the scapula's limited number of bony attachments, its stability and
mobility primarily rely on the coordinated actions of surrounding muscles,
underscoring the delicate balance between bone structure and muscular function in
facilitating fluid and precise movements.1 Ensuring proper coordination among the
muscles surrounding the scapulothoracic joint is imperative to maintain its stability.
The dynamic positioning of the glenoid for effective glenohumeral mobility
heavily relies on the functionality of the scapular muscles. Any weaknesses or
dysfunctional aspects within the scapular musculature can alter the normal scapular
posture and mechanics. An ineffective shoulder complex function not only affects
neuromuscular performance negatively but also increases the risk of glenohumeral
joint damage if the scapula fails to provide adequate stabilization. It is crucial to
address any issues promptly to prevent further complications in the shoulder complex
and maintain optimal joint health.2 Optimal scapula kinematics are crucial for
ensuring the shoulder joint functions at its best, especially when it comes to executing
repetitive hand-over-head movements with ease. When the scapula moves correctly, it
enhances the overall performance and efficiency of the shoulder joint, allowing for a
greater range of motion and better muscular engagement during activities that involve
raising the hands above the head.3 In both the static position and throughout the upper
limb's range of motion, winging or scapular asymmetry may manifest. Such
occurrences often stem from disruptions in scapular kinematics induced by factors
like weakened or dysfunctional scapular muscles, fatigue, and variations in cervical
spine or thoracic posture.
64
Introduction
These alterations can lead to visible asymmetries in the shoulder region,

affecting overall movement patterns and potentially causing discomfort or restricted
motion during various upper limb activities. Understanding these potential causes is
crucial in addressing and managing such dysfunctions effectively.4
Figure 1. Clinical presentation of Scapular Dyskinesis5
The broad term "dys" (alteration of) "kinesis" (motion) is used to characterize
situations where there is a noticeable loss of control regarding the normal mechanics,
physiology, and range of movement associated with the scapula. This loss of control
is crucial to understand due to the scapula's integral role in facilitating the coordinated
movement of the shoulder joint, known as scapulohumeral rhythm. Not only does the
scapula play a key part in ensuring efficient shoulder and arm function, but it is also
intricately linked to various clinical shoulder conditions.6 The implications of these
alterations can be observed in both the static positions of the scapula, representing its
resting state, as well as in the dynamic movements it performs during shoulder and
arm activities.7
Upper cervical laxity, thoracic outlet syndrome, headaches, back discomfort,
shoulder pain, and neck pain can all be attributed to scapular dyskinesia. This
condition can lead to a variety of symptoms that impact the upper body, causing
discomfort and reduced mobility. To ascertain whether or not they are a likely source
of neck, back, and shoulder pain, it is crucial to examine the surrounding muscles and
64
Introduction
the scapula's range of motion.

By evaluating the strength and function of these key areas, healthcare
providers can better understand the underlying issues contributing to the patient's
symptoms and develop an appropriate treatment plan to address them effectively. 8
From a physiological standpoint, the scapula plays a crucial role as the primary origin
point for the muscles responsible for arm movement and stability of the glenohumeral
joint (GH). This foundation not only facilitates the generation of arm motion but also
contributes significantly to maintaining dynamic stability in the shoulder complex.
Additionally, the muscles originating from the scapula heavily rely on scapular
stability to effectively exert force during various movements.
The relationship between the scapula and humerus is essential for successful
arm movement, with the scapulohumeral rhythm (SHR) governing the coordinated
motion necessary for optimal alignment and joint stability in the glenohumeral joint.
The interplay of these structures highlights the intricate and interdependent nature of
shoulder function, emphasizing the critical role the scapula plays in supporting
efficient arm mechanics and overall joint health. 9 Scapular dyskinesis, which is not
solely confined to a specific response to a particular glenohumeral pathology but
instead manifests as a generalized reaction to various sources of shoulder pain, can be
triggered by a multitude of causes. These include, but are not limited to, nerve
damage, injuries to the acromioclavicular (AC) joint, superior labral tears, rotator cuff
injuries, muscle weakness or imbalances, and pathologies affecting the elbow such as
ulnar collateral ligament rupture. Consequently, the scapula's function within the
scapula-humeral rhythm may undergo alterations due to the presence of dyskinesis.10
Dyskinesis, a term used to describe the abnormal scapular position at rest,
encompasses various manifestations such as winging of the scapula, marked by the
excessive prominence of the medial scapular border, and irregular scapular motion
during arm elevation, which manifests as a lack of smooth and coordinated movement
ability. Individuals displaying pronounced shoulder shrugging while raising their arm
may be lacking coordination among their upper, middle, and lower trapezius muscles.
In fact, shoulder dysfunction is closely associated with the position and mobility of
the scapula in a significant portion, around 68%, of cases. This underscores the
importance of recognizing and addressing these scapular abnormalities as they can
have a notable impact on overall shoulder function and movement efficiency.11
64
Introduction
Scapular dyskinesis, which is a common issue associated with various causes

like force uncoupling and muscular imbalance, can have significant implications on
the body's biomechanics. One vital aspect to consider is the role of muscular balance,
as it plays a crucial part in maintaining proper posture and facilitating the smooth
flow of energy throughout the kinetic chain. The intricate interaction between
muscles such as the rhomboids, serratus anterior, and upper and lower trapezius is
instrumental in determining the positioning of the scapula. Consequently, any
disruptions in muscle activation patterns or scapular movement can lead to overuse
injuries in the periscapular stabilizers, especially when repetitive movements are
involved, like those seen in sports such as tennis.
One specific consequence of scapular dyskinesis is the alteration in glenoid
orientation, manifesting as changes in protraction, retraction, and the inferior
positioning of the scapula. This deviation from the norm arises from a lack of
synchronized protraction/retraction movements and inadequate scapular elevation,
resulting in a narrowing of the subacromial space and compromising the clearance of
the rotator cuff beneath the acromion. Such structural changes not only affect
shoulder function but also increase the risk of impingement syndromes and other
shoulder pathologies, highlighting the importance of addressing scapular dyskinesis
early on to prevent further complications and optimize musculoskeletal health. 12
When considering activities other than weightlifting, such as daily movements or
specific exercises involving maximal arm and scapular mobility, it becomes evident
that scapular protraction, specifically in the "plus" position, can have detrimental
effects on overall shoulder function. These negative impacts include a decrease in
rotator cuff strength, heightened stress on the anterior glenohumeral ligaments, an
increased risk of internal impingement, a reduction in subacromial space, a rise in
impingement symptoms, and a greater strain on the muscles responsible for
stabilizing the scapula. As a result, the primary emphasis in most treatment plans for
scapular dyskinesis revolves around restoring functional retraction capabilities to
promote optimal shoulder health and performance.13
64
Introduction
Type-1 indicates the scapula's dorsal prominence at the inferior angle. The
complete medial border's dorsal prominence is represented by type-2. The scapula
may also be anteriorly displaced from the posterior thorax. Type 3 denotes the
elevated superior border of the scapula. The bilateral scapular symmetry is
represented by type-4.14
Figure 2 Showing the types of Scapular Dyskinesia15
The symptoms of this syndrome are referred to as SICK, an acronym

indicating dyskinesis of scapular movement, coracoid discomfort and malposition,
inferior medial border prominence, and scapular malposition. It's crucial to note that
another reason why throwing athletes with dead arm ache may experience shoulder
pain corresponds to the recently identified overuse muscle exhaustion syndrome. In
individuals presenting with this condition, the scapula may exhibit an asymmetric
malposition in the dominant throwing shoulder. This malposition often manifests
during physical examination, noticeable by one shoulder appearing lower than the
other. This defining characteristic indicates the presence of this specific illness,
emphasizing the importance of early diagnosis and tailored treatment strategies for
effective management and recovery.16
When evaluating scapular dyskinesis, various techniques can be employed,
including measuring scapular displacements, performing remedial exercises,
conducting ocular inspections, and utilizing advanced instruments like 3-D motion
analysis systems. While these methods are beneficial in a therapeutic context, in-
depth motion analysis systems typically provide more precise quantitative data
concerning scapula movements. For instance, assessing scapular displacement from
the trunk can be achieved through a user-friendly, quantitative approach.
64
Introduction
Take, for example, the lateral scapular slide test, where the scapular position
is elevated, and the distance between the scapula's inferior angle and the thoracic
spine's spinous process is gauged at 0, 40, and 90 degrees of glenohumeral abduction
in the coronal plane along the same horizontal line. Unfortunately, this method only
permits a static assessment of scapular position.
The scapula functions as a bridge between the shoulder complex and the
cervical spine and plays a very important role in providing both mobility and stability
of the neck/shoulder region. The association between abnormal scapular positions and
motions and glenohumeral joint pathology has been well established in the literature,
whereas studies investigating the relationship between neck pain and scapular
dysfunction have only recently begun to emerge. Although several authors have
emphasised the relevance of restoring normal scapular kinematics through exercise
and manual therapy techniques, overall scapular rehabilitation guidelines decent for
both patients with shoulder pain as well as patients with neck problems are lacking.
The purpose of this paper is to provide a science-based clinical reasoning algorithm
with practical guidelines for the rehabilitation of scapular dyskinesis in patients with
chronic complaints in the upper quadrant.
To further evaluate scapular dyskinesis, corrective maneuvers like the
scapular help test can be employed. During this test, the examiner corrects any
anomalous scapular movements that occur during arm elevation. Furthermore, the
muscular energy technique, a form of stretching where the patient resists the
therapist's counterforce, can aid in expanding joint mobility by surpassing the limited
range of motion. This helps to enhance flexibility and reach new ranges within the
joints. By requiring the patient to engage their muscles before stretching, the
muscular energy technique is particularly beneficial for strengthening weak or flaccid
muscles.
The non-invasive Muscle Energy Technique serves multiple purposes,
including strengthening weakening muscles physiologically, lengthening contracted
or spastic muscles, reducing localized edema to alleviate passive congestion, and
mobilizing joints with restricted mobility. Leveraging the patient's gentle muscle
contractions and appropriate body positioning, this technique promotes the restoration
64
Introduction
of normal joint motion. Although the primary emphasis lies on soft tissues, the
muscle energy technique also significantly contributes to joint mobilization,
highlighting its versatile applications in rehabilitation and physical therapy settings. 17
Scapular dyskinesis may be caused by a loss of function of the AC joint as a

stable fulcrum of the shoulder girdle, or by the superior shoulder pain caused by
dislocation. In fact, the literature reports that superior shoulder pain can lead to
scapular muscle weakness, especially at the inferior trapezius and serratus anterior,
explaining why different shoulder pathologies presenting with shoulder pain are
associated with scapular dyskinesis
The non-invasive Muscle Energy Technique offers a versatile approach to
address various musculoskeletal issues. This technique can be effectively utilized in
clinical settings to tackle a multitude of concerns related to muscle functionality and
joint mobility. By harnessing the power of the patient's gentle muscle contractions
and strategic body positioning, Muscle Energy Technique aids in strengthening
muscles that are experiencing physiological weakening, elongating shortened or
spastic muscles, alleviating localized oedema to ease passive congestion, and
mobilizing joints with restricted mobility. While the primary focus of this approach
lies in soft tissue manipulation, it also boasts a significant impact on facilitating joint
mobilization, thus promoting overall musculoskeletal health and function.18
The therapist plays a crucial role in the process, utilizing their expertise to
effectively tailor the Muscle Energy Technique (MET) according to the individual
patient's needs. This involves instructing the patient to engage the specific muscle
identified as weak by the therapist, and applying resistance in the form of an
isometric contraction. Additionally, the therapist has the flexibility to vary the timing
of this resistance as needed, ensuring a customized approach that maximizes the
therapeutic benefits of the MET for the patient's specific condition. 19 This technique
involving the lengthening of tight fascia and muscles serves to enhance the flexibility
of joints by expanding their range of motion.
64
Introduction
The extensibility of muscles can be effectively improved through the

application of two key concepts: post isometric relaxation, a method that targets
muscle tension reduction through controlled contractions followed by relaxation, and
reciprocal inhibition, a process that involves activating specific muscle groups to
promote the relaxation of their antagonistic counterparts. By integrating these
strategies into the treatment, practitioners can achieve significant enhancements in
muscle flexibility and joint mobility.20
Manual Electrical Therapy (MET) is a versatile technique that can be applied

to enhance localized circulation, build strength in weakened muscle groups,
effectively release tension in fascia and tight muscles, increase mobility in restricted
joints, and alleviate discomfort. Moreover, the corrective benefits of MET extend to
improving postural alignment, reestablishing normal joint biomechanics, and
enhancing functional movement patterns for overall physical wellness. 21
64
Introduction
1.1 Need of Study

Literature suggests that scapula plays a crucial role in coordinating and
maintaining complex shoulder kinematics. Alteration of soft tissue, such as local
inflexibility and muscle stiffness, is the most common reason for abnormal shoulder
motion.11
There are many articles suggesting that the increase in muscle strength and ROM can
lead to decrease the dyskinesis22, there are lack of study suggesting the effect of
muscle energy technique on strength and functionality dyskinesis.
This study will take into account the effect of muscle energy technique on pain,
ROM, strength and functionality in scapular dyskinesis. By the results of the study,
we can determine the effect of muscle energy technique.
1.2 AIM OF THE STUDY:

To determine the effect of muscle energy technique on pain, ROM, strength,
and functionality in scapular dyskinesis
1.3 OBJECTIVE OF THE STUDY:

 To see the effect of Muscle Energy Technique on Pain, Range of Motion,
Strength and Functionality in scapular dyskinesis.
 To see the effect of Conventional Physiotherapy on Pain, Range of Motion,
Strength and Functionality in scapular dyskinesis.
1.4 RESEARCH QUESTION:

Is there any effect of muscle energy technique on pain, ROM, strength and
functionality in scapular dyskinesis?
1.6 HYPOTHESIS
Null Hypothesis (H0): There will be no significant effect of muscle energy technique
on pain, ROM, strength and functionality in scapular dyskinesis.
Alternative Hypothesis (H1): There will be significant effect of muscle energy
technique on pain, ROM, strength and functionality in scapular dyskinesis
64
Review of Literature
CHAPTER 2
REVIEW OF LITERATURE:
1. Anand 2023 Forward Neck and Rounded Shoulder is one of an incorrect posture.
Craniovertebral angle, rounded shoulder posture measurement and posture screen
mobile are the types of outcome measures to assess the conditions. To find the
effect of the Muscle Energy Technique and Stabilization Exercise on the forward
neck and rounded shoulder for elite swimmers. Study Design: Experimental
study. Method: The study design was an experimental study, 30 male elite
swimmers were selected from Pondicherry Swimming Pool Academy, They were
allocated divided into two groups, Group A (n=15) Muscle Energy Technique
and Stabilization Exercise Group B (n=15) Conventional treatment, 3 sessions in
a week for 6week, The outcome measure (Craniovertebral angle, Rounded
Shoulder Posture Measurement and posture screen mobile) were measured in pre
and post-test for 6 week period. Results: Data analysis was done by unpaired ‘t’
test and paired ‘t’ test for the between group and within the group analysis
respectively, The statistic analysis done with unpaired ‘t’ test within the Group A
and Group B analyses is shown significance (p <0.01). Which shows that Group
A must be significant than Group B, it have been concluded that Group A shows
improvement in rounded shoulder and forward neck posture in elite swimmer
with the outcome measures than Group B. Conclusion: This study concludes that
the Muscle Energy Technique and Stabilization Exercise (Group-A) shows more
significant improvement in rounded shoulder and forward neck Posture in elite
swimmers when compared with conventional treatment (Group–B)
2. Ayman A. Mohamed 2022 The purpose of this study was to measure the effect
of adding vertical downward correction to dynamic scapular recognition exercise
on scapular dyskinesis and shoulder pain and disability in people with adhesive
capsulitis. Sixty-seven participants with adhesive capsulitis were randomized into
2 groups. After 2 weeks, there were significant differences between the taping
intervention group and the comparison group in scapular dyskinesis, scapular
upward rotation, shoulder flexion, abduction, and Shoulder Pain and Disability
Index (P < .05), and nonsignificant differences in shoulder external rotation (P
64
> .05). This study demonstrated that from adding taping with a vertical
downward correction to dynamic scapular recognition exercises, significant
short-term and long-term improvements in scapular dyskinesis and shoulder pain
and disability in people with adhesive capsulitis were observed. These
improvements persisted for 6 months after intervention.
3. Jin-Young Park 2022 study help to assess scapular dyskinesis precisely with
help of 3-dimensional wing computer tomography. 89 athletes were videotaped
and seven blinded observers categorized scapular dyskinesis into 4 types, which
was followed by 3-dimensional (3D) wing computer tomography (CT). Four
blinded examiners evaluated 5 angles [upward rotation (UR), internal rotation
(IR), anterior tilting (AT), superior translation (ST), and protraction (PRO)] on
the 3D wing CT. Inter-rater reliability (IRR) was calculated for both methods. CT
scan measurements were compared with the 4 observational posture screen
mobile) were measured in pre and post-test for 6 week period. Results: Data
analysis was done by unpaired ‘t’ test and paired ‘t’ test for the between group
and within the group analysis respectively, The statistic analysis done with
unpaired ‘t’ test within the Group A and Group B analyses is shown significance
(p <0.01). Which shows that Group A must be significant than Group B, it have
been concluded that Group A shows improvement in rounded shoulder and
forward neck potypes to establish the validity. The study concluded that 3D wing
CT analysis allows precise quantification of a position associated with scapular
dyskinesis. Therefore, 3D wing CT can be considered as an alternative method
for assessing scapular dyskinesis.
4. Kamonseki 2022 To investigate whether scapular movement training (SMT) is

superior to standardized exercises in improving scapular biomechanics,
behavioral, and clinical aspects of individuals with shoulder pain. A total of 64
individuals with chronic shoulder pain were randomly assigned to receive 16
sessions of SMT or SE over 8 weeks. Both groups significantly improved pain,
disability, fear-avoidance, Kinesio phobia, and self-perceived changes over 4
weeks, which was sustained over the remaining 8 weeks. SMT is not Technique
and Stabilization Exercise on the forward neck and rounded shoulder for elite
swimmers. Study Design: Experimental study. Method: The study design was an
64
experimental study, 30 male elite swimmers were selected from Pondicherry

Swimming Pool Academysuperior to standardized exercises in improving
scapular biomechanics, behavioral, and clinical aspects of individuals with
shoulder pain.
5. Pretshia DR 2022 A study was conducted to see the effect of Muscle Energy
Technique on Strength and Range of Motion in Young Swimmers with Sick
Scapula Syndrome: A Pre-Post Clinical Trial. In this study 26 subjects with sick
scapula syndrome were taken into the study by evaluating through the lateral
scapular slide test (LSST), the subjects affected were given a muscle energy
technique to increase the strength of the scapular muscles the technique was
given for 45-60 seconds thrice in a week for three weeks and all the subjects were
immediately assessed using MMT. The results demonstrate that Muscle energy
techniques are effective in increasing the range of motion and strength in young
swimmers within the age group of 8 to 15 years with sick scapular syndrome.
6. Sağlam G 2022 study help to evaluate the prevalence of scapular dyskinesia in

patients with neck, back, and shoulder pain and examine the variations in clinical
parameters cause by this combination. A total of 121 patients with neck, back, or
shoulder pain were included in this prospective cross-sectional study.
Demographic and clinical data of the patients were recorded. It was evaluated the
intensity of pain with the visual analog scale (VAS), the presence of muscle
shortness with muscle shortness tests, and scapular dyskinesia with the Lateral
Scapular Slide Test. Data analysis was done by unpaired ‘t’ test and paired ‘t’ test
for the between group and within the group analysis respectively, The statistic
analysis done with unpaired ‘t’ test within the Group A and Group B analyses is
shown significance (p <0.01). Which shows that Group A must be significant
than Group B, it have been concluded that Group A shows improvement in
rounded shoulder and forward neck potypes The study concluded of the presence
of scapular dyskinesia in a physical examination in patients with neck, back,
and/or shoulder pain will be a guide for the diagnosis and treatment of pain-
related problems.
64
7. Sciascia A 2022 conducted study has conflicting views that provided clear
recommendations for optimal evaluation and treatment methods. The study
concluded examination should not exclude assessments related to identifying
pathoanatomical causes but the pathoanatomical approach should not be the
primary focus of the examination. Using clinician experience and the best
available evidence, a qualitative examination for determining the presence or
absence of a scapular contribution to shoulder dysfunction is currently the best
option widely available to clinicians. Finally, rehabilitation approaches should be
reconsidered where enhancing motor control becomes the primary focus rather
than increasing strength.
8. Shiny 2022 Adhesive capsulitis (frozen shoulder) is an insidious painful

condition with gradual restriction of all planes of movement in the
shoulder. Muscle energy techniques are class of soft tissue osteopathic
manipulation consisting of isometric contraction design to improve
musculoskeletal function and reduce pain. MethodsPatients were divided
into two groups, Group A (15 participants) and Group B (15 participants).
Group A (experimental group) patients were treated with Muscle energy
techniques for shoulder along with Conventional treatment. Group B
(control group) patients were treated with Conventional physiotherapy
treatment only. We measured the range of motion, pain and disability of
shoulder at 0 day, 2nd week and 4th week. At the end of 4th week analysis
was done using paired and unpaired t-test and significant results were
found. Result-Both the groups showed significant difference and
improvement after treatment. However, greater magnitude of %
improvement was observed in the Group A i.e. the experimental group
than the Group B i.e. control group. Conclusion- Muscle energy technique
along with conventional treatment was significantly effective in improving
pain, disability, and range of motion in adhesive capsulitis patients
64
9. Diana Cabral Teixeira 2021 Scapular dyskinesis can be present in healthy

individuals as in patients with shoulder pathology. Altered patterns of scapular
kinematics can cause or exacerbate rotator cuff tear pathology. However, more
research is needed. Regardless of the cause or the consequence of rotator cuff
tear, scapular dyskinesis impairs shoulder function, worsens the symptoms, and
compromises the success of clinical intervention. The available literature
suggests physical therapy as the first treatment for degenerative cuff tears, and
scapular dyskinesis should be addressed if present. Non-responsive cases or
traumatic tears may require surgery. Postsurgical physical therapy protocols after
rotator cuff repair must consider scapular dyskinesia to improve the outcomes.
SD may be the cause, the result, or the compensating mechanism of RC lesions.
The clinician must consider early recognition and treatment of SD in patients
with RCT to accomplish the best clinical outcomes. At the end of 4th week
analysis was done using paired and unpaired t-test and significant results were
found. Result-Both the groups showed significant difference and improvement
after treatment. However, greater magnitude of % improvement was observed in
the Group A i.e. the experimental group than the Group B i.e. control group.
While conservative treatment may be sufficient for certain patients with SD and
RCT, others necessarily require surgery followed by proper rehabilitative
strategies.
10. Hwang, Myeungsik 2021 The purpose of this study was to compare the effects
of scapula stabilization exercise training involving muscle strengthening, muscle
balance, and movement control exercises on office workers with scapula
dysfunction. A total of 42 office workers with scapula dyskinesis were recruited
and randomly divided into three groups: muscle strengthening exercise group (n
= 14), muscle balance exercise group (n = 14), and movement control exercise
group (n = 14). The participants underwent 18 sessions (25 min/session, 3 days a
week for 6 weeks) of training involving the three types of exercises. The study
concluded that proprioceptive neuromuscular facilitation can be used as a
rehabilitation intervention for scapula position and movement, pain reduction,
and functional improvement in office workers with scapula dyskinesis.
64
11. Lan Tang 2021 Periarthritis of the shoulder is a common disease leading to
dysfunction of the shoulder joint and have a significant impact on patients’ daily
life. Evidence shows that there is a close relationship between scapular
dyskinesis (SD) and shoulder diseases. Scapular stabilization exercise has been
proved to be efficacious in relieving pain and improving function. However,
there is no targeted exercise based on the type of scapular dyskinesis. This study
will investigate the potential of scapular stabilization exercise based on the type
of scapular dyskinesis in treating periarthritis of the shoulder. This study is the
first study to investigate the clinical efficacy of scapular stabilization exercise
based on the type of scapular dyskinesis in patients with periarthritis of the
shoulder. The results may provide evidence of the effect of targeted scapular
stabilization exercise in improving shoulder function and correcting scapular
dyskinesis, and provide valuable information for future research.
12. Toufic R. Jildeh 2021 Purpose of Review Scapulothoracic dyskinesis (SD)

occurs when there is a noticeable disruption in typical position and motion of the
scapula, which can result in debilitating pain. The purpose of this review is to
describe the current knowledge regarding the diagnosis and management of
scapulothoracic dyskinesis by providing an evidence-based overview of clinical
exams and treatment modalities available for orthopedic surgeons and provide
insight into which treatment modalities require further investigation. The main
goal of the treatment of SD is to regain proper scapular positioning and
dynamics. The standard of care for the management of SD is conservative
interventions aimed at optimizing scapular kinematics. Surgical intervention is
only considered in the presence of concomitant pathology requiring surgery. The
present a concise review of clinical exams and treatment modalities available for
orthopedic surgeons in the management of SD. Data analysis was done by
unpaired ‘t’ test and paired ‘t’ test for the between group and within the group
analysis respectively, The statistic analysis done with unpaired ‘t’ test within the
Group A and Group B analyses is shown significance (p <0.01). Which shows
that Group A must be significant than Group B, it have been concluded that
Group A shows improvement in rounded shoulder and forward neck
64
13. Pritesh 2020 The shoulder plays a vital role in many athletic activities.
Overhead motions repetitively place the shoulder in vulnerable positions
possibly leading to injuries. During bowling in cricket, glenohumeral (GH)
joint reaches extremes of motion, velocity and forces. Posterior shoulder
stiffness results from repetitive microtrauma which leads to the
development of fibrotic scar tissue of the posterior capsule. This leads to
posterior shoulder tightness and alteration of GH joint ROM. Muscle
energy technique has been used to increase the flexibility, and ROM of a
restricted joint. The basic principle is post-isometric relaxation. Materials
and Methods: The study was conducted at Nashik District Cricket
Association. The duration of the study was 5 months. Total sample size
was 30. Subjects were divided into 2 groups of 15 each. group A- MET
and passive stretching group B-mobilization and passive stretching. 4
treatment sessions in a week for 2 weeks were performed. Materials used
were Goniometer, pen, paper and consent form. Results: The P value was<
0.05 in group A, so the result was statistically significant, i.e. MET and
passive stretching is effective. The P value was < 0.05 in group B, so the
result was statistically significant, i.e. mobilization and passive stretching
is effective. The P value was< 0.05 in group A, so the result was
statistically significant, i.e. MET and passive stretching is effective.
14. Sundeep S. Saini 2020 This article aims to provide a comprehensive

understanding of the evaluation, diagnosis, and management of scapular
dyskinesis and its impact on the kinetic chain in tennis athletes. Recent Findings
Optimal glenohumeral biomechanics are intimately associated with proper
scapular motion and function. The tennis serve requires the scapula to act as a
force transducer in the kinetic chain to convert potential energy generated in the
lower extremities to kinetic energy in the upper extremity. Any aberration within
this complex kinetic chain will result in force uncoupling and increases the
potential for injury through compensatory mechanisms. Specifically, scapular
dyskinesis has been associated with an increased risk of shoulder pain of up to
43% in overhead athletes. These pathologies include rotator cuff disease,
subacromial and posterior impingement, labral injuries, and SLAP tears.
64
Conservative management remains the mainstay of treatment and consists of a

graduated physical therapy regimen. Although shoulder pain in the overhead
athletes is often multifactorial, early recognition and treatment of scapular
dyskinesis generally carry a favorable prognosis and result in improved patient
outcomes.
15. Y. SHANTHOSHRAJA 2019 To compare the effectiveness of Muscle Energy

Technique and Maitland mobilization coupled with Ultrasound in patients with
periarthritis of shoulder joint. 20 subjects with periarthritis were randomly
allocated. The subjects were treated Ultrasound coupled with Muscle Energy
Technique (Group I) and Maitland Mobilization (Group II). The treatment was
given for 45 minutes a day up to 2 months. The outcome was measured in terms
of shoulder pain and disability index (SPADI). Ultrasound coupled with muscle
energy technique is more effective than Maitland mobilization in reducing pain
and disability, enhancing shoulder function among periarthritis subjects
16. Gopinath 2018 Adhesive capsulitis is a self-limiting condition of

unknown aetiology. The present cross-sectional study included 50 subjects
with the history of adhesive capsulitis (phase II) selected based on the
inclusion and exclusion criteria. They were randomly allocated into two
study groups. The duration of the treatment intervention was 6 sessions per
week for the duration of two weeks. Based on the above data analysis it is
evident that Group A showed significant improvement than Group B. This
implies that Gong’s mobilisation is more beneficial in improving ROM,
reducing pain, improving functional ability. Conclusion: The present study
concludes that Gong’s mobilisation is more effective than muscle energy
technique in subjects with phase II adhesive capsulitis
17. Maddox L. Reed 2018 To compare the acute effectiveness of MET and joint
mobilizations for reducing posterior shoulder tightness, as measured by passive
GH horizontal adduction and internal rotation ROM, among high school baseball
and softball players. Glenohumeral passive adduction and internal rotation ROM
were measured in all participants in a pre-test post-test fashion. Between testing,
the joint mobilization group received one application of GH posterior joint
64
mobilizations. The MET group received one cycle of MET applied to the GH
horizontal abductors. The control group received no intervention. Post-tests
measures were completed immediately following intervention or a similar
amount of time resting for the control group and then again 15 minutes later. The
results of this study indicate the application of MET to the horizontal abductors
provides acute improvements to GH horizontal adduction ROM in high school
baseball and softball players, while joint mobilizations provide no improvements.
18. Tsun-Shun Huang 2018 The study recruited 38 amateur overhead athletes with
subacromial impingement and scapular medial border prominence who were
randomly assigned to the VF or control group. The participants in both groups
controlled the scapular position and progressively practiced from 0° to 45° and
from 0° to 90° of arm elevation. Participants in the VF group also controlled the
scapular position with a video presentation of the scapula on a screen. We
investigated the scapular kinematics, muscle activation, and balance ratio for
outcome collection in the preintervention and postintervention conditions with
and without VF conditions. The progressive control of scapular orientation with
or without VF can be used to reduce the UT/LT ratio and improve scapular
internal rotation during arm elevation. Control training with VF can further
decrease the UT/serratus anterior ratio.
19. Walter Osias 2017 Symptomatic scapulothoracic disorders, including

scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders
involving the scapulothoracic articulation that have the potential to cause
significant patient morbidity. Scapulothoracic crepitus is the presence of a
grinding or popping sound with movement of the scapula that may or may not be
symptomatic, while scapulothoracic bursitis refers to inflammation of bursa
within the scapulothoracic articulation Imaging is an important adjunct to the
physical examination for accurate diagnosis and appropriate treatment
management. Non-operative management such as physical therapy and local
injection can be effective for symptoms secondary to scapular dyskinesis or
benign, non-osseous lesions. Surgical treatment is utilized for osseous lesions, or
if non-operative management for bursitis has failed. Open, arthroscopic, or
combined methods have been performed with good clinical outcome.
64
20. W. Benjamin Kibler 2012 The scapula plays a key role in nearly every aspect of
normal shoulder function. Basic science and clinical research findings have led to
the identification of normal three-dimensional scapular kinematics in
scapulohumeral rhythm and to abnormal kinematics in shoulder injury, the
development of clinical methods of evaluating the scapula (eg, scapular
assistance test, scapular retraction test), and the formulation of rehabilitation
guidelines. Primary scapular presentations such as scapular winging and
snapping should be managed with a protocol that is focused on the scapula.
Persons with associated conditions such as shoulder impingement, rotator cuff
disease, labral injury, clavicle fracture, acromioclavicular joint injury, and
multidirectional instability should be evaluated for scapular dyskinesis and
treated accordingly
64
Material and Methodology
CHAPTER 3
MATERIAL AND METHODOLOGY
3.1 ETHICAL CLEARANCE : The present study received approval from Institutional
Ethical Committee of Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute
of Medial Sciences (Deemed to be University) Loni, Ahmednagar, Maharashtra, India,
413736, registration no. PIMS/DR.APJAKCOPT/IEC/2023/168 dated on 21st February
2022. (APPENDIX-A)
3.2 TRIAL REGISTRATION : The study was a parallel group randomized controlled
trial registered in Clinical Trial Registry of India (CTRI/2023/07/054696) dated
03/07/2023. (APPINDIX-C)
3.3 Source of Data: Out- Patient Department, Pravara Rural Hospital
3.4 Study setting: Department of Musculoskeletal Physiotherapy at Dr. APJAK
College of Physiotherapy, PIMS, LONI.
3.5 Type of Data: Quantitative data
3.6 Intervention period: 50-60 mins per session for 3 days in a week for 8 weeks
3.7 Study Design: Single Blinded Randomized Controlled Trial
3.8 Study Duration: 2 years
3.9 Sample size: 52 (calculated with open-epi, the previous article was referred
having common intervention but different population)
3.10 Sampling Method: Simple Random Sampling
3.11 Equipment-
 Goniometer
 Weight cuff
3.12 Materials used:
 Consent Form
64
3.13 SELECTION CRITERIA:

Inclusion criteria:
Participants included were:
 Age 20 to 60 years
 Unilateral shoulder pain
 Restricted shoulder movement
 A maximum pain score of equal or less than 5/10 on VAS on activity
 Scapular assistance test
 Scapular retraction test
 Type 1 and 2 of scapular dyskinesis seen on observation
 Patients volunteered to participate in the study and signed informed consent
Exclusion criteria:
Participants excluded were:
 The presence of any shoulder problem contraindicating exercises of the shoulder
 joint such as active inflammatory disease
 Active infection
 Recent subluxations or dislocations
 Fractures
 Surgeries near the shoulder region
 Patients with scoliosis or acute cervical spondylosis.
 Patients who are not cooperative
64
3.14 OUTCOME MEASURES:

The outcome measures used for this study are as follows,
 Constant Murley Scale (reliability-0.80) 23
 Pain intensity was assessed using the visual analogue scale (VAS), which ranks
pain from 0 (no pain) to 10 (most severe pain) and has good reliability with an
intraclass correlation coefficient (ICC) of 0.71–0.99.
 The shoulder active range of motion (AROM) including flexion (FL), abduction
(AB), external rotation (ER), and internal rotation (IR) was measured with a two-
arm standard goniometer with a good reliability (ICC 0.91 to 0.99)
64
3.15 RANDOMIZATION AND ALLOCATION

Random number generation was done by MS Excel. Randomization was
done using Sequentially numbered opaque sealed envelope (SNOSE) technique. The
random number were written into 46 chits and they were covered with aluminon foil
and these were placed individually in opaque sealed envelope which was signed and
sealed by principal investigator.
64
3.16 PROCEDURE:
 The Participants was selected based on the inclusion and exclusion criteria for
eligibility. Informed consent is obtained from the participants and demographic
data is recorded.
 Participants was randomly allocated to 2 groups that is experimental
group(n=26) and the conventional group(n=26). Prior assessment of the
participants was done.
 Group A received conventional therapy for 3 times for a week for 8 weeks.
 Upper trapezius stretches
 Posterior shoulder stretch
 Pectoralis minor stretch
 Lateral rotation strengthening exercise
 Scapular retraction strengthening exercise
 Serratus anterior strengthening exercise
 Abduction strengthening exercise
 Group B that is the experimental group was received the Muscle Energy
Technique for scapular muscle and conventional treatment and Group B was
received conventional physiotherapy treatment for scapular dyskinesis.
Treatment for group B was Muscle Energy Technique which was given passively
by therapist 3 times a week for 8 weeks. Muscle groups such as trapezius,
Pectoralis minor, major, levator scapulae subscapularis and infraspinatus were
included.
64
INTERVENTION
Muscle MET Technique
1.Trapeizus The therapist asks the patient to either side bend the cervical spine to
the or elevate the shoulder. Alternatively, the patient may be
requested to perform both of these actions at the same time against a
resistance from the therapist or ask the patient to bring the ear to the
shoulder, or the shoulder to the ear, against a resistance, holding for
10 seconds. Then patient is asked to relax, take a breath in, and on
the relaxation phase, the cervical spine is taken further into opposite
side bend.
2.Petoralis The patient adopts a supine position and the therapist places their
Minor hand under the patient’s shoulder blade. The therapist then controls
the anterior aspect of the patient’s shoulder. The patient is asked to
protract the scapula for the appropriate time. After the contraction,
the therapist encourages the scapula into a retracted position this
will encourage a lengthening of the pectoralis minor.
3.Pectoralis The arm is taken away from the body into the scapular plane to
Major induce a lengthening of fibres of the pectoralis major, and the
therapist will be palpating for the point of bind before they perform
an MET. From the point of bind, the patient is asked to pull their
arm across the body
(Horizontal flexion) to induce a contraction of the pectoralis major.
Once the patient has contracted for 10 seconds, the patient is asked
to place hand on pectoralis major and the therapist places their hand
on top. The therapist then controls the patient’s arm and slowly
takes the shoulder further away into the scapular plane. This will
induce a lengthening of the fibres of the pectoralis major
4.Levator The hand positioning is similar to that for the upper trapezius, the
Scapulae difference being that the patient’s cervical spine is held more into
flexion to achieve the point of bind. From the point of bind, the
patient is asked to push their cervical spine into extension to initiate
the contraction of the levator scapulae. After the appropriate time
and on the relaxation, the patient’s cervical spine is taken into
64
further flexion, with an added rotational movement.

5.Subscapularis The therapist takes the patient’s shoulder into external rotation until
a bind is felt, and from this position, the patient is asked to contract
the subscapularis by internally rotating their shoulder. After 10
seconds and on the relaxation phase, the therapist applies traction to
the shoulder joint (to prevent an impingement) and slowly
encourages the shoulder into further external rotation.
6. Infraspinatus The therapist takes the shoulder into internal rotation until the point
of bind is felt and from this position, the patient is asked to
externally rotate the shoulder, which will activate the infraspinatus.
After the 10-second contraction, the therapist applies traction to the
shoulder and slowly encourages the shoulder into further internal
rotation.
64
Figure 3.1 CONSORT Flow chart representing procedure of selection of

participants.
64
Figure 3.2 MET for Trapezius
Figure 3.3 MET for Pectoralis Minor
64
Figure 3.4 MET for Pectoralis Major
Figure 3.5 MET for Levator Scapulae
64
Figure 3.6 MET for Subscapularis
Figure 3.7 MET for Infraspinatus
64
Data Analysis and Interpretation
CHAPTER 4
DATA ANALYSIS AND INTERPRETATION
Analysis of data was done using the IBM SPSS Software Window V.28.0.1.0
version. Descriptive statistics for all outcomes measures expressed as means, standard
deviations and test significance. Test for normality was done by Shapiro wilk test
which shown that the data was normally distributed as the value was p>0.05.
Therefore, a parametric test (t-test) was used with the Confidence Interval set as 95%.
Paired t-test was used to compare the difference between the pre- and post-
intervention values within the groups on different parameters and Unpaired t-test was
used to compare the difference between the pre- and post-intervention values between
the groups on different parameters.
The study was conducted in scapular dyskinesis individuals, which is done in Pravara
institute of medical science on the basis of inclusion and exclusion 52 samples were
taken. In which 2 groups were made group B in which subjects were given the
Muscle Energy Technique and group A were given conventional treatment.
Table 1: Age, Gender wise distribution in participants of both groups
Variable Control Experimental
Gender Female 13 11
Male 10 12
14 Gender wise distribution in both groups

12
10
0
Control Experimental
MALE FEMALE
Graph 1: Gender-wise distribution in both groups
64
Table 2 : Showing Demographic Data Analysis

Variables Control Experimental p-value
Age 39.5 + 11.4 39.9 + 10.2 0.9
Height 160.8 + 9.31 166.6 + 10.6 0.5
Weight 58.9 + 9.76 63.5 + 9.44 0.12
Affected side (Left) 12 10
(Right) 11 13 0.56
Age, Height, Weight distribution in both

groups
180
160
140
120
100
80
60
40
20
0
Age Height Weight
Affected side distribution in both groups

14
12
10
0
RIGHT LEFT
Graph 2: Graph Showing Baseline Demographic Data Analysis
64
BASELINE CHARACTERTICS OF OUTCOME MEASURES
Table 3: Baseline values of all outcome’s measures of both groups

Variables Control Experimental
VAS 7 + 1.50 7.39 + 1.31
Range of Motion
Flexion 102.95 + 22.43 98.37 + 14.27
Abduction 104.95 + 23.54 104.69 + 21.71
Internal Rotation 57.3 + 8.00 60.04 + 7.03
External Rotation 64.91 + 12.40 71.69 + 9.97
CMS score
Pain 6.19 + 3.60 5.3 + 2.43
ADL 11.13 + 2.73 10.43 + 3.60
ROM 24.69 + 5.48 26.52 + 5.08
Strength 15.4 + 3.44 14.53 + 3.08
Visual Analoug Scale

10
9
8
7
6
5
4
3
2
1
0
Graph 3: Baseline score of VAS in both groups
64
Range of Motion
120
100
80
60
40
20
0
Flexion Abduction Internal Rotation External Rotation
Graph 4: Baseline score of Range of Motion in both groups
Constant Score
30
25
20
15
10
0
PAIN ADL ROM POWER
Graph 5: Baseline score of CMS in both groups
64
WITHIN GROUP ANALYSIS

VISUAL ANALOGUE SCALE
Paired t-test is used to compare means of the pre intervention and post
intervention score of Visual Analogue Scale in both Experimental and Control group.
In Experimental group t- value is 17.42 and the p-value is <0.0001 which indicates
significant difference in pre and post score. In Control group t- value is 3.42 and the
p-value is 0.002 which also indicates significant difference in pre and post score.
VAS PRE POST t-value p-value

Control 7 + 1.50 6.30 + 1.39 3.42 0.002
Experimental 7.39 + 1.31 1.26 + 1.07 17.42 <0.0001
Table 4: Comparison of means of pre and post values of both groups

(VAS)
VAS
8
0
Pre Post
Graph 6: Within group comparison of Visual Analogue Scale
64
1. RANGE OF MOTION
Paired t-test is used to compare means of the preintervention and post-
intervention score of Range of Motion using Goniometer in both Experimental and
Control groups. In Control Group, for Flexion the t-value is 6.20 and the p-value is
<0.0001, Abduction the t-value is 5.41 and the p-value is <0.0001, Internal Rotation
the t-value is 7.49 and the p- value is <0.0001, External Rotation the t-value is 6.58
and the p- value is <0.0001 which indicates significant difference in pre and post
score. In Experimental group, for Flexion the t-value is 12.16 and the p-value is
<0.0001, Abduction the t-value is 9.25 and the p-value is <0.0001, Internal Rotation
the t-value is 7.01 and the p- value is <0.0001, External Rotation the t-value is 7.28
and the p- value is <0.0001 which also indicates significant difference in pre and post
score
CONTROL
PRE POST t-value p-value
Flexion 102.95 + 22.55 113.43 + 19.58 6.20 <0.0001
Abduction 104.95 + 23.54 115.08 + 21.16 5.41 <0.0001
Internal 57.30 + 8.00 60.82 + 7.13 7.49 <0.0001

Rotation
External 64.91 + 3.60 70.21 + 11.59 6.58 <0.0001
Rotation
Table 5: Comparison of Control group means of pre and post values of

both groups (Range of Motion)
64
EXPERIMENTAL
PRE POST t-value p-value
Flexion 95.39 + 14.27 132.43 + 18.62 12.16 <0.0001
Abduction 104.69 + 21.71 147.3 + 22.69 9.25 <0.0001
Internal 60.04 + 7.03 68.56 + 5.60 7.01 <0.0001
Rotation
External 71.69 + 9.97 85.91 + 5.00 7.28 <0.0001
Rotation
Table 6: Comparison of Experimental group means of pre and post values

of both groups (Range of Motion)
Flexion
140
120
100
80
60
40
20
0
Pre Post
Graph 7: Within group comparison of Range of Motion (Flexion)
64
Abduction
160
140
120
100
80
60
40
20
0
Pre Post
Graph 8: Within group comparison of Range of Motion (Abduction)
Internal Rotation
70
68
66
64
62
60
58
56
54
52
50
Pre Post
Graph 9: Within group comparison of Range of Motion (Internal

Rotation)
64
External Rotation
100
90
80
70
60
50
40
30
20
10
0
Pre Post
Graph 10: Within group comparison of Range of Motion (External
Rotation)
64
2. CONSTANT SCORE
Paired t-test is used to compare means of the preintervention and post-
intervention score of Constant Murley Scale in both Experimental and Control
groups. In Control Group, the t- value is 7.25 and the p-value is <0.0001 which
indicates significant difference in pre and post score. In Experimental group t- value
is 26.24 and the p-value is < 0.0001 which also indicates significant difference in pre
and post score.
CMS Scale PRE POST t-value p-value

Control 57.03 + 12.95 66.59 + 3.24 7.25 <0.0001
Experimental 55.93 + 7.3 88.66 + 6.05 26.25 <0.0001
Table 7: Comparison of means of pre and post values of both groups

(Constant Murley Scale)
Constant Score
100
90
80
70
60
50
40
30
20
10
0
Pre Post
Graph 11: Within group comparison of Constant Murley Scale
64
Intergroup comparison of mean between Experimental and Control

Group
1. Visual Analoug Scale
Mean of post intervention values of Visual Analogue Scale of both groups is
compared using unpaired t- test which shows p values of <0.0001 and t value of 13.43
indicating significant difference between both groups.
Variable Control Experimental t-value p-value

VAS 6.30 + 1.39 1.26 + 1.07 13.43 <0.0001
Table 8: Comparison of mean of post score of VAS
Visual Analoug Scale

7
0
Graph 12: Between the group comparison of VAS
64
2. Range of Motion
Unpaired t-test is used to compare means of the pot intervention score of
Range of the Motion between Control and Experimental Groups. In which Flexion t-
value is 5.83 and the p-value is <0.0001, Abduction the t-value is 4.82 and the p-
value is <0.0001, Internal Rotation the t-value is 4.89 and the p- value is <0.0001,
External Rotation the t-value is 5.83 and the p- value is <0.0001 which indicates
significant difference in pre and post score.
Control Experimental t-value p-value
Flexion 113.43 + 19.58 132.43 + 18.62 5.83 <0.0001
Abduction 115.08 + 21.61 147.3 + 22.69 4.82 <0.0001
Internal 60.82 + 7.13 68.56 + 5.60 4.89 <0.0001
Rotation
External 70.21 + 11.59 85.91 + 5.00 5.83 <0.0001
Rotation
Table 9: Comparison of mean of post score of Range of Motion
Range of Motion
160
140
120
100
80
60
40
20
0
Flexion Abduction Internal Rotation External Rotation
Graph 13: Between the group comparison of Range of Motion
64
64
3. Constant Score
Unpaired t-test is used to compare means of the pot intervention score of
Constant Score between Control and Experimental Groups. In which Pain the t-value
is 11.04 and the p-value is <0.0001, ROM the t-value is 7.73 and the p-value is
<0.0001, ADL the t-value is 5.53 and the p- value is <0.0001, Strength the t-value is
4.61 and the p- value is <0.0001 which indicates significant difference in pre and post
score.
Control Experimental t-value p-value

Pain 7.63 + 2.51 13.89 + 0.87 11.04 <0.0001
ROM 27.13 + 5.58 37.13 + 2.34 7.73 <0.0001
ADL 14.13 + 2.62 18.30 + 2.36 5.53 <0.0001
Strength 16.69 + 3.24 19.33 + 2.54 4.61 <0.0001
Table 10: Comparison of mean of post score of Constant Score
Constant Score
100
90
80
70
60
50
40
30
20
10
0
PAIN ADL ROM POWER
Graph 14: Between the group comparison of Constant Score
64
Discussion
CHAPTER 5
DISCUSSION
5.1 Overview:
Objective of the study was to see the effectiveness of Muscle Energy
Technique on Pain using Visual Analogue Scale, Range of Motion using Goniometer,
Functional Disability and Strength using Constant Murley Scale among patients with
Scapular Dyskinesis. 59 participants were assessed out of which 10 participants did
not meet the inclusion criteria and 3 participants refused to participate in the study, so
randomization was done and 46 participants were included. Out of 46 participants, 23
participants were divided in Group A i.e. Control Group who received Conventional
Physiotherapy and 23 participants were divided into Group B i.e. Experimental Group
who received Muscle Energy Technique. Mean age of the participants in Group A
was 39.5 + 11.4 and Group B was 39.9 + 10.2 and there were 10 males and 13
females in Control Group and 12 males and 11 females in Experimental Group.
The VAS score, Range of Motion and the Constant Score is measured
before the intervention. Group A which is Control Group was received the
Conventional treatment which is Upper trapezius stretches, Posterior shoulder stretch,
Pectoralis minor stretch, Lateral rotation strengthening exercise, Scapular retraction
strengthening exercise, Serratus anterior strengthening exercise, Abduction
strengthening exercise. Group B which is Experimental Group was received the
Muscle Energy Technique was given passively by the therapist for Trapezius,
Pectoralis minor, major, Levator scapulae, Subscapularis and Infraspinatus. The VAS
score, Range of Motion and the Constant Score was again measured after 8 weeks of
intervention in both groups.
According to the data analysis the main findings in the experimental group is:
a) Decrease in pain intensity
b) Increase in Range of Motion and strength
c) Increase in Functionality
64
Discussion
1) VISUAL ANALOGUE SCALE
The paired t-test was applied to compare the VAS scale for within group pre
and post t- test value of control group is 3.42 (p-value 0.002) which is statistically
significant. This finding of current study suggests that pain caused due to scapular
dyskinesis may subside by the help of conventional physiotherapy. Further, this
finding is supported by
ELIF et.al (2017) who concluded that conventional exercise therapy and scapular
stabilization exercise are both effective and safe tool for controlling pain and
improving disability status in scapular dyskinesis. DANILO et. al (2022) who
conducted a study in which conventional exercises help in improving scapular
biomechanics, behavioural, and clinical aspects of individuals with scapular
dyskinesis pain.
Similarly paired t-test was applied to compare the VAS scale for within group
pre and post t- test value of experimental group is 17.42 (p-value < 0.0001) which is
statistically significant. This finding of current study suggests that pain caused due to
scapular dyskinesis may subside by the help of muscle energy technique. These
findings are supported by DEKA et.al (2023) conducted a study in which results
shows significant difference in VAS in follow up period compare to Myofascial
release group and MET received for upper trapezius, levator scapulae, Rhomboid
muscle produce pain relief according to the Gate-control theory where
mechanoreceptor afferents carried by large diameter axons inhibit nociceptor
afferents at the dorsal horn of the spinal cord.
PHADKE et.al (2016), who conducted a study in which MET group received
Post isometric relaxation technique to the upper trapezius and levator scapulae
muscles and concluded that Muscle energy technique was better than the stretching
technique in improving pain and functional disability in people with mechanical neck
pain. As pain intensity was reduced on VAS score by the inhibitory effect of MET on
upper trapezius and levator scapulae muscle.
64
Discussion
For between group comparison unpaired t-test was applied in which the t-
value is 13.43 and p-value is < 0.0001, which show that the that pain caused due to
scapular dyskinesis may subside better by the help of muscle energy technique
combined with conventional physiotherapy. ISHAQ et.al (2023) conduced that Both
MET and MWM were effective for symptomatic management in this sample of 40
patients with subacromial impingement syndrome. MET seems to show some
superior effects in pain as compared to MWM. Finding of these studies are in line
with our study and shown that the Muscle Energy Technique shows significant
improvement in pain intensity on VAS score. GANESH et.al (2020) results
demonstrate that of Muscle energy technique is effective in increasing the range of
motion and strength in Sick scapula in swimmers.
64
Discussion
2) RANGE OF MOTION
The paired t-test was applied to compare the range of motion for within group
pre and post t- test value of control group for flexion is 6.20 (p-value <0.0001),
abduction is 5.41 (p-value <0.0001), internal rotation is 7.49 (p-value <0.0001),
external rotation is 6.58 (p-value <0.0001) which are statistically significant. This
finding of current study suggests that decrease range of motion caused due to scapular
dyskinesis may increase by the help of conventional physiotherapy. Further, this
finding is supported by AFSUN et.al (2017) concluded the effectiveness of
conventional exercise (scapular strengthening exercise, scapular stabilization
exercise, scapular muscle stretching) on scapular position and motion of individuals
with scapular dyskinesis. TANG et.al (2021) states that the scapular stabilization
exercise as well as the conventional treatment helps in improving shoulder function
and correcting scapular dyskinesis.
Similarly paired t-test was applied to compare the range of motion for within
group pre and post t- test value of experimental group for flexion is 12.16 (p-value
<0.0001), abduction is 9.25 (p-value <0.0001), internal rotation is 7.01 (p-value
<0.0001), external rotation is 7.28 (p-value <0.0001) which are statistically
significant. This finding of current study suggests that decrease range of motion
caused due to scapular dyskinesis may increase with the help of Muscle Energy
Technique. This result is supported by STEPHANIE D et.al (2017) conducted a study
on in which results shows that A single application of an MET for the GHJ horizontal
abductors provides immediate improvements in both GHJ horizontal adduction and
internal rotation ROM in asymptomatic collegiate baseball players compare to
conventional physiotherapy.
RAKSHA R et.al (2021) a study concluded that both the techniques used in
the present study i.e., Spencer Muscle Energy Technique and Maitland Mobilization
are effective for improving pain, reducing disability, and increasing ROM. However,
MET is the more effective for improving pain, reducing disability, and increasing
ROM compared to Maitland Mobilization in patients with frozen shoulders.
64
Discussion
For between group comparison unpaired t-test was applied in which the t-value
for flexion is 5.83 (p-value <0.0001), abduction is 4.82 (p-value <0.001), internal
rotation is 4.89 (p-value <0.0001), external rotation is 5.83 (p-value <0.0001) which
are statistically significant, which show that range of motion decreased due to
scapular dyskinesis may increase by the help of muscle energy technique with
conventional physiotherapy. Further, this finding is supported by MALLICK et.al
(2023) concluded that MET combined with conventional exercise was more effective
in improving the joint stiffness, pain, and ROM, of those who had restricted shoulder
joint range of motion and any injury to the shoulder joint acute condition. Finding of
these studies are similar to this study which shows that the Muscle Energy Technique
was effective in increasing the Range of Motion as it improves normal extensibility of
capsule, restore joint play and stretches the tightened soft tissues and periarticular
structures. ALI et.al (2022) this study contradicts the result of our studies as this study
concluded that Maitland Mobilization is more effective in reducing pain and
increasing function and Disability among the patients having Adhesive Capsulitis as
compared to MET for ROM.
64
Discussion
3) CONSTANT MURLEY SCALE
The paired t-test was effectively used in the study to compare the constant
murley score within the group before and after the intervention. The results showed
significant improvements in various parameters for the control group, with pain
demonstrating a decrease to 3.42 (p-value 0.002), ADL increasing to 7.36 (p-value
<0.0001), range of motion slightly improving to 1.73 (p-value 0.093), strength
notably increasing to 8.05 (p-value <0.0001), and the total score significantly rising to
7.25 (p-value <0.0001). These findings indicate that the decrease in constant murley
score attributed to scapular dyskinesis can potentially be reversed with conventional
physiotherapy. Furthermore, the study aligns with research by ZHANG et.al. (2015),
which demonstrated the effectiveness of a combination of conventional rehabilitation
interventions and scapular training exercises in treating shoulder dysfunction.
Notably, enhanced scapula training exercises were found to have a stronger positive
impact on shoulder function based on the Constant Score assessment.
Similarly, the paired t-test was employed to compare the constant murley
score within the experimental group, revealing significant improvements in pain,
which decreased to 17.35 (p-value <0.0001), ADL improving to 10.42 (p-value
<0.00001), range of motion advancing to 12.12 (p-value <0.0001), strength reaching
7.77 (p-value <0.0001), and total score surging to 26.24 (p-value <0.0001). These
results suggest that the introduction of Muscle Energy Technique may help alleviate
the constant murley score decrease associated with scapular dyskinesis. Additionally,
DEJACO et.al. (2017) corroborated these findings, showing significant increases in
the Constant Murley score and notable decreases in VAS scores after 26 weeks in
both study groups.
For comparing between the control and experimental groups, an unpaired
t-test was conducted, revealing noteworthy differences. The t-values for pain, ADL,
range of motion, strength, and total score were 11.04 (p-value <0.0001), 5.53 (p-value
<0.0001), 7.73 (p-value <0.0001), 4.61 (p-value <0.0001), and 8.95 (p-value
<0.0001) respectively, with all outcomes displaying statistical significance. This
study aligns with the research by CORREIA et.al. (2022), which highlighted higher
proportions of patients achieving clinically significant improvement in Constant
64
Discussion
Murley scores. Overall, the comprehensive analysis of these results suggests the
potential efficacy of the interventions in improving shoulder function and enhancing
the quality of life for individuals affected by scapular dyskinesis.
5.2CONCLUSION
The study, which aimed to evaluate the impact of Muscle Energy Technique
on scapular awkward kinetics and position in individuals with Scapular Dyskinesis,
revealed significant improvements in both the group that received Muscle Energy
Technique along with Conventional Physiotherapy and the group that received
Conventional Physiotherapy alone, as indicated by statistical analysis.
Moreover, drawing from the findings, the study's conclusion emphasizes the
superiority of combining Muscle Energy Technique with Conventional Physiotherapy
over utilizing Conventional Physiotherapy alone for the treatment of scapular
dyskinesis. This suggests that the integrated approach may offer more effective
outcomes in scapular dyskinesis.
64
Discussion
LIMITATION
1. The first limitation is the small sample size.
2. The lack of long-term follow up to confirm the effect of Muscle Energy Technique in long
term
3. Patients with only unilateral involvement were included
CLINICAL IMPLICATION
Muscle Energy Technique is safe, effective and feasible in decreasing in pain
intensity and increase in Range of Motion and strength and also functionality
FUNDING
No Funding sources
64
Discussion
5.3 CONFLICT OF INTEREST

 Authors declare no potential conflict of interest related to this article.
64
References
CHAPTER 6
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64
Appendix
APPENDIX A
ETHICAL COMMITTEE CLEARENCE
CERTIFICATE
64
Appendix
APPENDIX B
CLINICAL TRIAL REGISTRY OF INDIA
64
Appendix
APPENDIX C
PARTICIPATION INFORMATION AND INFORMED
CONSENT
INFORM CONSENT FORM
“Effect of Muscle Energy Technique on pain, ROM, strength, and

functionality in scapular dyskinesis: A RCT”
I __________________________agree to take part in the research study conducted by
Siddhi V Parab (MPT Student) from the department of Musculoskeletal Physiotherapy,
PIMS, COPT, LONI.
Gender: _______ Age: ______
Address: ____________________________________________________________________
Occupation: ___________________________________
I confirmed that I have read and understood the information sheet

dated___/__/___ for the above study and have had the opportunity to ask
questions.
I understand that my participation in the study is voluntary and that I am free to

withdraw at any time, without giving any reason, without my medical care or
legal rights being affected.
I understand that my identity will not be revealed in any information released to

third parties or published.
I agree not to restrict the use of any data or results that arise from this study
provided such a use is only for scientific purpose(s).
I agree to take part in the above-mentioned study.
Signature of the patient: ______________________ Date_________
Signature of the investigator: ________________ Date________
64
Appendix
सूचित संमती फॉमम:

र्मक: स्केप्युलर डिस्किनेसिसमधील वेदना, गतीची श्रेणी, ताकद आणि कार्यक्षमतेवर स्नायू ऊर्जा
तंत्राचा प्रभाव: RCT
सहभागी नाव _______________________________________________________________
पत्ता_________________________________________________________________
1.मी पुष्टी करतो की ततने तीने मला सं धनाचे उद्दिष्ट, प्रोटोकॉल, फायदे आणि
मी अनुभवू शकणारे संभाव्य धोके स्पष्ट केले आहेत. मला दिलेल्या माहिती मी
वाचली आति समजून घेतली आणि मला प्रन श्नविचारण्याची संधी देण्यात
आली.
2.मी या संशोधनात स्वयंसेवक म्हणून सहभागी होण्यास इच्छुक आहे आणि

मला माहीत आहे की मी कोणतेही कारण देता कधीही माघार घेऊ शकतो.
3. मला खात्री देण्यात आली आहे की माझी ओळख कोणत्याही माहितीमध्ये,

कोणताही वेळी, तृतीय पक्षांना किंवा प्रकाशकाला उघड केली जाणार नाही.
वैज्ञानिक उद्देश I साठी वापरला डेटा वगळता.
सहभागीची स्वाक्षरी किंवा अंगठ्याचा ठसा_________________

तारीक ___________
अन्वेषक:
मी सहभागीला संशोधनाचे उद्दिष्ट , संशोधनाचा उद्देश, आवयककश्य
कार्यपद्धती आणि माझ्या क्षमतेनुसार
संभाव्य जोखीम आति फायदे पूर्णपणे स्पष्ट के ले आहेत. मी सहभागींना समजण्यासाठी सर्वतोपरी प्रयत्न
केले आणि सर्व शंकांचे निरसन केले. या अभ्यासातील सहभागी स्वेच्छेने आणि जाणूनबुजून
तपासकत्यायला सूचित संमती देत आहेत. या अभ्यासातून मिळालेला डेटा गोपनीय असेल.
तपासकर्त्याचे नाव- मिस .सिद्धी विनोद परब
स्वाक्षरी- __________________
तारीक- ____________
64
Appendix
APPENDIX D
64
Appendix
APPENDIX I
PLAGIARISM REPORT
64
Appendix
APPENDIX J
MASTER CHART GROUP A-(INTERVENTION)
WEEK 0 WEEK 8
Sr. Age Gender Height Weight Side Constant Score Pain Range of Motion Constant Score Pain Range of Motion
no (VAS) (VAS)
Abduction
Abduction
Range of
Rotation
Rotation
Rotation
Rotation
External
External
Internal
Internal
Activity
Activity
of daily
Flexion
Flexion
Motion
Motion
Power
Range
Power
living
living
Total
Total
daily
Pain
Pain
of
of
1 25 M 152 48 Right 9.5 9 18 12.6 55.1 8 60 78 48 62 13.5 20 32 17.2 82.7 3 100 94 60 75
2 46 F 164 65 Left 6 9 24 14.6 53.6 7 95 100 62 80 13 11 34 16.32 75.8 2 147 120 70 89
3 37 M 157 56 Right 5 8 28 12 53 6 100 92 68 78 14 17 38 21.34 83.3 3 120 110 79 85
4 27 M 150 60 Right 4 5 28 16.4 53.4 6 79 80 70 90 13.5 18 36 20.17 85.7 4 158 100 70 90
5 38 F 162 48 Right 10 7 32 16.8 65.8 9 89 120 64 87 13.5 20 40 20.7 94.2 1 157 160 70 90
6 43 M 145 75 Left 6.5 13 30 16.5 66 6 100 137 60 71 14.5 20 38 21.4 93.9 0 140 150 68 85
7 27 F 164 60 Right 8.5 14 22 14.2 58.7 8 90 110 58 76 13 20 32 18.4 83.4 2 138 140 65 80
8 39 F 160 46 Left 4 6 26 12.6 48.6 9 104 120 60 70 13.5 17 38 19.6 84.9 1 160 148 70 90
9 59 M 154 68 Right 4 13 28 21.1 66.1 7 110 148 52 84 14.5 20 38 22.4 94.9 2 143 159 70 86
10 40 M 163 66 Left 5 11 30 14.8 60.8 9 95 120 49 78 14 20 40 21.4 95.4 1 164 170 64 85
11 36 F 176 74 Right 4.5 12 32 12.6 61.1 7 89 137 63 83 14.5 18 38 22.8 93.3 0 139 168 66 90
12 53 M 178 64 Left 7 8 24 15 54 9 70 100 58 60 15 18 36 22.56 87.6 0 140 159 70 90
13 33 M 174 70 Right 0 6 20 10.8 36.8 10 69 90 47 57 11 12 36 19.63 73.9 2 157 153 60 83
14 22 M 180 79 Left 3 10 26 14.8 53.8 8 80 100 65 74 15 20 38 20.9 93.9 1 140 170 70 90
15 37 F 165 61 Left 5 11 32 9.4 57.4 7 60 96 67 79 14 20 38 21.54 88.8 2 135 150 70 88
16 45 M 187 50 Right 5.5 13 26 20.7 59.3 6 87 90 57 62 14.5 18 36 20.7 89.2 1 140 165 65 80
17 34 F 167 64 Right 6.5 20 40 19.1 65.6 5 98 120 69 52 15 20 40 22.4 97.4 0 153 172 70 86
18 57 F 165 54 Left 7 11 28 13.4 59.4 7 100 140 50 62 14 18 40 21.2 93.2 1 138 168 65 72
19 48 F 171 71 Left 6 11 24 17.2 58.2 6 86 90 62 72 14 18 38 18.2 88.2 0 130 169 70 90
20 29 M 177 72 Right 7.5 6 16 12.6 42.1 8 59 61 54 65 14.5 20 36 22.8 93.3 1 127 140 60 83
21 54 M 165 67 Left 3.5 7 28 8.8 47.3 9 79 89 63 74 14.5 18 34 17.6 84.1 1 129 124 86 89
22 38 F 176 65 Right 4 14 26 15 59 6 89 100 70 73 13.5 20 40 17.28 90.7 0 159 160 70 90
23 51 F 182 78 Right 0 16 22 13.4 51.4 7 76 90 65 60 13 18 38 22.4 91.4 1 138 140 69 90
64
Appendix
64
Appendix
MASTER CHART GROUP B-(CONTROL)

WEEK 0 WEEK 8
Sr. Age Gender Height Weight Side Constant Score Pain Range of Motion Constant Score Pain (VAS) Range of Motion
no (VAS)
Abduction
Abduction
Range of
Rotation
Rotation
Rotation
Rotation
External
External
Internal
Internal
Activity
Activity
Motion
of daily
Flexion
Flexion
Motion
Range
Power
Power
living
living
Total
Total
daily
Pain
Pain
of
of
1 40 F 162 45 Right 4.5 9 22 10.6 46.1 8 70 84 48 55 10 10 28 12.7 60.7 6 82 90 52 59
2 27 M 150 67 Left 2 6 24 12.6 44.6 7 120 97 58 60 5.5 11 26 15 57.5 6 130 100 60 65
3 38 F 157 48 Right 7.5 13 26 13.1 59.6 6 95 110 49 72 8 16 28 13.4 65.4 5 97 111 52 75
4 57 M 164 53 Right 2 9 26 15 52 8 120 104 57 83 7.5 15 30 17 69.5 5 136 128 62 87
5 25 F 152 74 Left 6 9 26 17.4 58.4 6 117 87 64 52 7 13 28 18.1 66.1 6 120 88 67 55
6 39 M 174 54 Left 8.5 11 24 17.1 60.6 7 98 109 60 69 9 13 28 18.5 68.5 7 100 124 62 71
7 59 F 170 79 Right 0 6 6 8.9 20.9 9 100 130 47 60 4 9 20 12.3 45.3 7 116 141 50 64
8 48 F 156 49 Left 5.5 10 26 17.1 58.6 7 92 90 56 61 6.5 12 30 17.9 66.4 6 100 98 62 68
9 25 F 163 59 Right 6 11 32 13.2 62.2 6 128 138 60 77 6.5 16 32 14.3 68.8 6 129 140 60 77
10 31 M 176 51 Left 9 11 26 13.4 59.4 8 130 142 49 53 7 16 30 14.3 67.3 9 131 140 55 60
11 33 M 167 69 Left 1.5 8 24 12.9 46.4 9 86 92 67 42 5 13 26 13.9 57.9 8 120 110 70 44
12 29 F 163 70 Right 9.5 13 24 18.6 56.1 7 89 100 70 87 10 15 28 20.4 73.4 6 105 110 70 90
13 49 M 148 49 Left 10.5 12 28 17.4 67.9 5 122 120 65 70 11 14 30 18 73 4 133 124 69 86
14 53 F 159 60 Left 6 13 32 15.1 66.1 6 136 143 54 68 6 17 8 16.5 71.5 6 137 145 55 70
15 24 M 152 57 Right 14 14 28 20.4 76.4 4 119 120 69 60 14 14 28 20.8 76.8 4 120 120 70 65
16 36 M 166 50 Right 6.5 11 22 15.2 54.7 8 78 80 49 50 6 12 26 16 60 9 92 85 55 62
17 29 F 170 47 Left 3.5 15 30 14.9 63.4 9 138 120 60 72 4.5 17 30 16 67.5 8 140 148 65 77
18 40 M 138 68 Left 4 14 24 18.8 60.8 8 90 100 68 82 5 13 26 19.2 63.2 7 98 114 70 85
19 58 F 159 60 Right 9.5 13 22 17.8 62.3 5 67 82 60 75 10 15 24 18.4 67.4 5 89 100 68 80
20 38 F 163 71 Left 10 16 30 19.2 75.2 5 110 132 59 68 10 18 34 20.5 82.5 5 112 149 61 72
21 57 F 149 50 Left 0 7 14 7.4 28.4 10 60 58 39 46 5 10 18 8.4 41.4 8 77 82 45 59
22 46 M 172 57 Right 6 11 24 17.2 58.2 7 76 60 49 51 7 18 36 18.6 79.6 7 83 81 56 60
23 28 F 169 69 Right 10.5 14 28 21 73.5 6 108 116 61 80 11 18 30 22.9 81.9 5 120 119 63 84
64
Appendix
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“EFFECT OF MUSCLE ENERGY TECHNIQUE ON PAIN,

RANGE OF MOTION, STRENGTH AND FUNCTIONALITY IN

In partial fulfilment of the

UNDER THE GUIDANCE OF

Dr. A. P. J. ABDUL KALAM COLLEGE OF PHYSIOTHERAPY,

I hereby declare that this dissertation entitled “EFFECT OF MUSCLE

Date: Signature of the candidate

I hereby declare that this dissertation “EFFECT OF MUSCLE ENERGY

Date: Signature of the guide

I hereby declare that this dissertation entitled “EFFECT OF MUSCLE

… Siddhi Vinod Parab

CHAPTER NAME OF TOPIC PAGE NO.

Table Title Page No.

Graph Title Page No.

Figure Title Page No.

The acromioclavicular and sternoclavicular joints, located on the clavicle,

These alterations can lead to visible asymmetries in the shoulder region,

Figure 1. Clinical presentation of Scapular Dyskinesis5

the scapula's range of motion.

Scapular dyskinesis, which is a common issue associated with various causes

Figure 2 Showing the types of Scapular Dyskinesia15

The symptoms of this syndrome are referred to as SICK, an acronym

Scapular dyskinesis may be caused by a loss of function of the AC joint as a

The extensibility of muscles can be effectively improved through the

Manual Electrical Therapy (MET) is a versatile technique that can be applied

1.1 Need of Study

1.2 AIM OF THE STUDY:

1.3 OBJECTIVE OF THE STUDY:

1.4 RESEARCH QUESTION:

4. Kamonseki 2022 To investigate whether scapular movement training (SMT) is

experimental study, 30 male elite swimmers were selected from Pondicherry

6. Sağlam G 2022 study help to evaluate the prevalence of scapular dyskinesia in

8. Shiny 2022 Adhesive capsulitis (frozen shoulder) is an insidious painful

9. Diana Cabral Teixeira 2021 Scapular dyskinesis can be present in healthy

12. Toufic R. Jildeh 2021 Purpose of Review Scapulothoracic dyskinesis (SD)

14. Sundeep S. Saini 2020 This article aims to provide a comprehensive

Conservative management remains the mainstay of treatment and consists of a

15. Y. SHANTHOSHRAJA 2019 To compare the effectiveness of Muscle Energy

16. Gopinath 2018 Adhesive capsulitis is a self-limiting condition of

19. Walter Osias 2017 Symptomatic scapulothoracic disorders, including

3.13 SELECTION CRITERIA:

3.14 OUTCOME MEASURES:

3.15 RANDOMIZATION AND ALLOCATION

further flexion, with an added rotational movement.

Figure 3.1 CONSORT Flow chart representing procedure of selection of

Figure 3.2 MET for Trapezius

Figure 3.3 MET for Pectoralis Minor

Figure 3.4 MET for Pectoralis Major

Figure 3.5 MET for Levator Scapulae

Figure 3.6 MET for Subscapularis

Figure 3.7 MET for Infraspinatus

14 Gender wise distribution in both groups

Graph 1: Gender-wise distribution in both groups

Table 2 : Showing Demographic Data Analysis

Age, Height, Weight distribution in both

Affected side distribution in both groups

Graph 2: Graph Showing Baseline Demographic Data Analysis

BASELINE CHARACTERTICS OF OUTCOME MEASURES

Table 3: Baseline values of all outcome’s measures of both groups

Visual Analoug Scale

Graph 3: Baseline score of VAS in both groups

Graph 4: Baseline score of Range of Motion in both groups

Graph 5: Baseline score of CMS in both groups

WITHIN GROUP ANALYSIS

Signature of the patient: ______________ Date_

Signature of the investigator: ________ Date