Effect of IASTM Combined Thrower's Ten Exercise Protocol on Snapping Scapula Syndrome in Badminton Player: A Case Report

Prasannajeet Nikam^*

^*Correspondence: Prasannajeet Nikam, Krishna College of Physiotherapy. Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharahstra, India, Email:

Author info »

Introduction

Instrument Assisted Soft Tissue Mobilisation (IASTM) is a unique approach to treat myo-fascial restrictions secondary to various acute as well as chronic soft-tissue injuries. Various devices like M2T blade, Graston’s IASTM devices, Rockblade are commercially available devices used to render IASTM [1-2].

Snapping scapula syndrome

Snapping scapula syndrome is defined as an audible or palpable clicking of the scapula during movements of the scapulo thoracic joint. It typically affects young, active patients, who often report a history of pain, resulting from overuse, during rapid shoulder movements or during sports activities. These symptoms can have insidious onset, can occur after a change in the pattern of physical activity, or can be associated with trauma [3-5].

Symptoms

What symptoms does snapping scapula cause?

Pain/aches in the shoulder area.

Grinding, grating, and snapping sensation in the shoulder blade.

A potential lump from a bone growth on the scapula.

Tissue in the affected area often feels thick.

Swelling in the shoulder area.

Shoulder instability.

Tenderness or stiffness [6].

Thrower's Ten Protocol

Thrower’s Ten Exercise protocol is designed to exercise major muscles required for throwing. It consists of the following set of exercises (Table 1) [7].

Table 1: Thrower’s ten protocol.

Need for the study

No physiotherapy treatment approach has been known to show improvements in Snapping Scapula Syndrome case. Treatment focus was only on the scapulo- thoracic joint previously. So, this case report was an attempt to advocate intervening peripheral associated structures as well.

Case Description

A 29 year old female badminton player presented with chief complaint of pain at the medial border of right scapula accompanied by a “ popping ” or “ snapping ” sound, while attempting flexion and abduction of the right gleno-humeral joint since 4-5 months. AROM of flexion and abduction was 130 degree and 164 degree respectively, which was severely compromised since the onset of the symptoms.

Thrower ’ s Ten Exercise protocol was given following Myo-fascial release of the muscles with the conventional physiotherapy treatments for 6 weeks. Sports Activity Dependant Antagonist Muscle Strengthening (SADAMS) was used to strengthen Biceps, triceps and forearm flexors. Post interventions data for various outcome measures like pain, AROM and Rate of Perceived Exertion was recorded.

Outcome measures

Visual Analogue Scale.

Active Range of Motion.

Borg Scale for Rate of Perceived exertion.

Detailed treatment protocol (week wise) (Figure 1)

Figure 1: Treatment protocol.

Results and Discussion

Reduced Pain scores- US and TENS

Improved Active ROM

Secondary to myo-fascial release with IASTM

Increased pain tolerance

Borg’s Scale- reduced RPE scores-Might be due to increased muscular endurance (Table 2).

Table 2: Pre and post scores.

Conclusion

Thus, the present case study concludes that Instrument Assisted Soft Tissue Mobilisation along with Thrower’s Ten Exercise Protocol following conventional physiotherapy (for pain relief) yielded clinically significant results in reducing pain & exertion levels as well as improved Active ROM in Snapping Scapula Syndrome.

References

1. Cheatham SW, Lee M, Cain M, et al. The efficacy of instrument assisted soft tissue mobilization: A systematic review. J Canadian Chiropractic Assoc 2016; 60:200-211. 
2. Laudner K, Compton BD, McLoda TA, et al. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. Int J Sports Physical Therapy 2014; 9:1–7.
3. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: Mechanisms and practical application. J Exerc Rehabil 2017; 13:12–22.
4. Baker RT, Nasypany A, Seegmiller JG, et al. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. Int J Athl Ther Training 2013; 18:16–21.
5. McMurray J, Landis S, Lininger K, et al. A comparison and review of indirect myofascial release therapy, instrument assisted soft tissue mobilization, and active release techniques to inform clinical decision making. In J Athl Ther Train 2015; 20:29–34.
6. Lazar MA, Kwon YW, Rokito AS. Snapping scapula syndrome. J Bone Joint Surg 2009; 91:2251–2262.
7. Gaskill T, Millett PJ. Snapping scapula syndrome: Diagnosis and management. J Am Acad Orthop Surg 2013; 21:214-224.