Effects of Abdominal Drawing-In Maneuver with Cross-Pattern Limb Exercises on Pain and Disability in Shoulder Impingement Syndrome: A Randomized Controlled Trial
Article Sidebar
Main Article Content
Abstract
Background: Shoulder impingement syndrome is a common cause of shoulder pain and functional limitation, often associated with altered scapulohumeral mechanics, rotator cuff dysfunction, and impaired kinetic-chain control. Objective: To determine the effects of abdominal drawing-in maneuver with cross-pattern limb exercises on pain and disability in patients with shoulder impingement syndrome. Methods: This randomized controlled trial was conducted at Akhtar Saeed Trust Hospital, EME, over six months. Forty-two eligible patients aged 30–50 years with clinical signs of shoulder impingement syndrome were randomly allocated to conventional physiotherapy or conventional physiotherapy plus abdominal drawing-in maneuver with cross-pattern limb exercises. Treatment was delivered for six weeks, three sessions per week. Pain and disability were assessed using the Shoulder Pain and Disability Index before and after intervention. Data were analyzed using SPSS version 27, with independent-samples and paired-samples t-tests applied at p < 0.05. Results: Thirty-eight participants completed follow-up analysis. Baseline SPADI scores were comparable between groups (p = 0.385). After six weeks, the experimental group showed significantly lower SPADI scores than the control group (16.73 ± 3.15 vs. 47.21 ± 15.25; mean difference = 30.47; 95% CI: 23.00–37.94; p < 0.001). Within-group improvement was significant in both groups, but greater in the experimental group. Conclusion: Adding abdominal drawing-in maneuver with cross-pattern limb exercises to conventional physiotherapy produced greater improvement in shoulder pain and disability than conventional therapy alone.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Shah M, Sutaria J, Khant A. Effectiveness of scapular stability exercises in the patient with the shoulder impingement syndrome. Indian J Phys Ther. 2014;2(1):79–84.
2. Horowitz EH, Aibinder WR. Shoulder impingement syndrome. Phys Med Rehabil Clin N Am. 2023;34(2):311–34.
3. Ibrahim MH, Nadia A, Hassan KA. Efficacy of core stability in treatment of patients with shoulder impingement syndrome: single blinded randomized controlled trial. 2024.
4. Gomora-García M, Rojano-Mejía D, Solis-Hernández JL, Escamilla-Chávez C. Effectiveness of physiotherapy on painful shoulder impingement syndrome. Cir Cir. 2016;84(3):203–7.
5. Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthop Res Rev. 2018;10:83–91.
6. Gutiérrez-Espinoza H, Méndez-Rebolledo G, Zavala-González J, Torreblanca-Vargas S, Araya-Quintanilla F. The effect of the addition of core exercises to supervised physiotherapy in patients with subacromial impingement syndrome. Int J Sports Phys Ther. 2025;20(2):210.
7. Nazari G, MacDermid JC, Bryant D, Athwal GS. The effectiveness of surgical versus conservative interventions on pain and function in patients with shoulder impingement syndrome: a systematic review and meta-analysis. PLoS One. 2019;14(5):e0216961.
8. Singh H, Thind A, Mohamed NS. Subacromial impingement syndrome: a systematic review of existing treatment modalities to newer proprioceptive-based strategies. Cureus. 2022;14(8).
9. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765.
10. Willardson JM. Core stability training: applications to sports conditioning programs. J Strength Cond Res. 2007;21(3):979–85.
11. Pogetti LS, Nakagawa TH, Conteçote GP, Camargo PR. Core stability, shoulder peak torque and function in throwing athletes with and without shoulder pain. Phys Ther Sport. 2018;34:36–42.
12. Burger M, Africa C, Droomer K, Norman A, Pheiffe C, Gericke A, et al. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: a systematic review and meta-analysis. S Afr J Physiother. 2016;72(1):1–9.
13. Ali S, Azazy M, Nassef S. Effect of core stability training on shoulder pain and range of motion in patient with impingement syndrome among manual operated hand workers. Int J Environ Stud Res. 2022;1(3):262–73.
14. Mısırlıoğlu TÖ, Eren İ, Canbulat N, Çobanoğlu E, Günerbüyük C, Demirhan M. Does a core stabilization exercise program have a role on shoulder rehabilitation? A comparative study in young females. Turk J Phys Med Rehabil. 2018;64(4):328.
15. Kim DE, Shin AR, Lee JH, Cynn HS. Effect of the abdominal drawing-in maneuver on the scapular stabilizer muscle activities and scapular winging during push-up plus exercise in subjects with scapular winging. Phys Ther Korea. 2017;24(1):61–70.
16. Ersever EM, Goktas B. The effect of core exercises on shoulder rotator strength, core endurance and supraspinatus structure in tennis players with rotator cuff injuries. J Tissue Viability. 2025;34(3):100934.
17. Mohamed AI, Shalaby ME, Fadel ME, Soliman ES. Effects of adding core stability training to conventional rehabilitation protocol on shoulder function after rotator cuff repair. Fizjoterapia Polska. 2024;(4).
18. Safari Zanjani F, Haghani A, Mousavi SH, Safari Zanjani H, Muniroglu S. The role of core stability exercises on internal rotator cuff muscles strength and its motor function in amateur archers. Phys Treat. 2022;12(2):93–102.
19. Larsson R, Bernhardsson S, Nordeman L. Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):446.
20. Espinoza HG, Araya-Quintanilla F, Pinto-Concha S, Valenzuela-Fuenzalida J, López-Gil JF, Ramírez-Vélez R. Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial. BMJ Open Sport Exerc Med. 2023;9(3).
21. El-Nashar H, ElWishy A, Helmy H, El-Rwainy R. Do core stability exercises improve upper limb function in chronic stroke patients? Egypt J Neurol Psychiatry Neurosurg. 2019;55(1):38.
22. Menek O, Aklar A, Alaca N, Subasi F. Do core stabilization exercises have an impact on pain, posture, and disability in shoulder impingement syndrome? Gevher Nesibe J Med Health Sci. 2025;10(1):69–81.
23. Kaur H, Chaudhary S, Chhabra C. Core strength as a paramount contributor for potential upper limb isometric strength: a correlational study. Cent Eur J Sport Sci Med. 2023;42(2).
24. Nuhmani S. Correlation between core stability and upper-extremity performance in male collegiate athletes. Medicina. 2022;58(8):982.
25. Radwan A, Francis J, Green A, Kahl E, Maciurzynski D, Quartulli A, et al. Is there a relation between shoulder dysfunction and core instability? Int J Sports Phys Ther. 2014;9(1):8–13.
26. Park C, Yoon S, Yoon H, Kim K, Cha Y, Park I. Effects of core stabilization exercise on muscle activity during horizontal shoulder adduction with loads in healthy adults: a randomized controlled study. J Mech Med Biol. 2021;21(09):2140049.
27. Rosemeyer JR, Hayes BT, Switzler CL, Hicks-Little CA. Effects of core-musculature fatigue on maximal shoulder strength. J Sport Rehabil. 2015;24(4):384–90.
28. Yörükoğlu AÇ, Şavkın R, Büker N, Alsayani KYA. Is there a relation between rotator cuff injury and core stability? J Back Musculoskelet Rehabil. 2019;32(3):445–52.
29. Price P, Prorok S. The effect of dynamic core stabilization on competitive adolescent swimmers with shoulder pain. Azusa Pacific University; 2019.