Effectiveness of Myofascial Release Therapy with Shoulder Taping on Subacromial Impingement Syndrome in Collegiate Basket Ball Players-A Quasi experimental Pilot study

Background: Shoulder complex dysfunction can arise when any of its components goes for malfunction. Overhead athletes cause impingement in the shoulder due to subacromial impingement or anterior instability. Myofascial tightness is found to be the common causative mechanism for the shoulder pain, though the literatures were not detailed in considering the myofascial tightness and the management. Aims & Objective: The aim of the study was to find out the effect of myofascial release therapy with shoulder taping on subacromial impingement syndrome in collegiate basket ball players. Quasi experimental pilot study with 38 collegiate basket ball players who participated in the university tournaments were selected for the study. 19 players in control group who under myofascial therapy whereas 19 players in experimental group who underwent shoulder taping and myofascial release therapy. Result: The outcome measures were pain and functional ability. Pain was assessed using numerical pain rating scale, and functional ability was assessed using SPADI. Unrelated ‘t’ test was done to evaluate the effect of the treatment for pain value between groups is 13.9 with the p value <0.05% and SPADI scale was 13.8 at the p value <0.05%. The result shows that the myofascial release therapy with shoulder taping shows more significant improvement than myofascial release therapy only. Conclusion: Study concludes that shoulder taping and myofascial release therapy helps in reducing pain and improvement of functional disability.


Introduction:
Subacromial impingement syndrome affects 44% to 65% of individuals and it is one of the common diagnoses in all shoulder problems. 1,2.Shoulder pain is the major contributor for non traumatic pain in the upper limb.Life time prevalence of the shoulder pain ranges from 7% to 36% of populations 3,4 .Subacromial impingement syndrome was defined as the compression of the subacromial structures like rotator cuff, bursa, tendons against the acromion and the coracoacromial ligament, as the greater tuberosity passes below while elevation of the arm 5 .Pain and dysfunction is the commonest symptoms occurs when the shoulder is placed in positions of elevation, activity which is very common in most sporting , vocational pursuits and daily living activities.Sports and work activities that require repetitive stress especially in the overhead position often overstress the muscles, ligaments and the capsule of the shoulder.Some individuals are also predisposed structurally to problems with the shoulder that may be exacerbated by certain activity.Sports like golf, badminton, basket ball, tennis, cricket and base ball has elevation as a component of sporting activities 6,7 .25%-60% of over head athletes / players will experience shoulder injuries 8,9 .Over head activities may cause forceful and repetitive nature of activities and cause microtrauma to the anterior region of the capsule, which may predispose to anterior shift of the humeral head, changing the rotational arc of the shoulder and increasing external rotation or reducing the internal rotation 9,10 .Myofascial syndrome leads to various neuromuscular pathologies.Treatment attempting to stabilize muscle will also resolve the tightness in the fascia and relieve pain.Common cause of the shoulder pain is myofascial pain which is caused by myofascial trigger points.Several literatures showed that myofascial tightness or trigger point leads to musculoskeletal pain..Management of the impingement of shoulder is done by various non operative procedures.Physiotherapist lays first line in the management of the shoulder problems.Various therapeutic options have been described by many authors still most are lacking with scientific background.Rehabilitation of shoulder joint invariably involves retraining of specific function of the contractile elements throughout motion and altering resting length of these components to improve lengthtension relationship and indirectly improves the scapulohumeral rhythm. 11aping is the commonly used modality in the clinical setting 12 .The use of tape by athletes is rapidly increasing in a therapeutic or in prophylactic reasons 13 .Myofascial release therapy is a hand on technique which is extensively used in the treatment of shoulder pain 15 .There are minimal studies focused on taping and myofascial release therapy.Though the extent of the myofascial therapy was briefed in articles the purpose of this study is to find out the effect of myofascial release therapy with shoulder taping on subacromial impingement syndrome in collegiate basket ball players.The study hypothesized that there will be no significant effect on myofascial release therapy with shoulder taping on subacromial impingement syndrome.

Materials and methodology:
Quasi experimental pilot study with 38 collegiate basket ball players were selected using systematic sampling method.After considering the inclusion and exclusion criteria, players were divided into two groups with equal number of participants.Study was conducted for a period of 6 weeks.The study includes male basket ball players, age group of 18 history of previous injury around shoulder, sever labrum or capsule tear, patient with radiating pain, severe pain around the shoulder, allergic to tape and skin infections.Block randomization process was used and randomly done 1 or 2 labeled envelops to determine their groups allocation, the subjects done 1 of remaining 2 envelops to and the process was repeated.A clear explanation about the study was given to every individual players and consent form was obtained from them.Both the groups underwent general advices about the shoulder.Control group receives myofascial release therapy for the shoulder whereas the experimental group receives myofascial release therapy with shoulder taping.The treatment was given alternative days.
Taping was applied following the myofascial release therapy and advised to maintain it till the next visit.(approximately 2 days).The myofascial release therapy is focused on stretch of pectoralis minor and pectoralis major, and anterior part of deltoid.Taping was applied with two straps, first anchored over the anterior deltoid muscle and extended posteriorly along with the spine of scapula.Second strap anchored anterior part of deltoid over the coracoids process and extended posterior and inferiomedially over the scapula which imitates the line of pull of lower trapezius.Pictorial representation of taping technique is in figure 1.
The pain and the functional disability was assessed in the first visit and then on every alternate week.
For the analysis we chose the values of first week and the 6 th week.The collected data was analyzed using SPSS package 19 Based on the statistical analysis and the myofascial release therapy with taping over the shoulder reduces the pain and improves the function of shoulder.
collegiate basket ball players.Shoulder pathology results in loss of function that increases with age.
It is generally considered that effective treatment depends on understanding the mechanism of onset and identification of appropriate structures which produce the symptoms.Scapular dysfunction often results in shoulder impingement syndrome 16,17 .Myofascial release therapy is beneficial in reducing pain and improving the function and range of motion of shoulder.The application of myofascial release therapy helps in improvement of viscoelastic properties of the muscles.This help in improvement of normal biomechanics of the shoulder which result in pan reduction and functional improvement 18,19 .Studies showed that the myofascial release around the shoulder muscle proves very effective.However, because these studies focus much on MTrPs, there is no direct evidence that these interventions did have or did not have an effect on MTrPs. 31aping helps in pain reduction by modulation of the pain fibers and altering the sensory input and facilitation or inhibition of the muscle activity 20 .
Taping help to stimulate the neuromuscular pathway via increased afferent feedback from cutaneous receptors and can facilitate neuromuscular response 21,22 .Taping stabilizes the joint act as splint and alters the length-tension relationship to create the required posture or movement pattern 21,23,24 .
Scapular taping is a useful adjunct for promoting proper scapular kinetics and it should be used with other interventions 25 .Elastic taping has positive changes in scapular motion and muscle performance 26 .Previous studies done by variety of researchers have reported clinical benefits from use of taping for subacromial impingement syndrome.

Conclusion:
The study concludes that the myofascial release therapy to the shoulder with taping helps in reducing pain and improvement of function in subacromial impingement syndrome.The study was directed to a particular sports group, work load, sleeping and the daily living activities are not under the control.Long term effect is not measured.The intra rater and inter rater reliability was not analyzed.This study will help future therapist include myofascial release therapy in the treatment protocol, myofascial release therapy doesn't require any kind of specialized equipment, but training is necessary for application and a clear understanding of the indications and precaution is needed for application of this technique.

Conflict of interest: None
-22 years, clinical diagnosis of subacromial Figure II: Basic information's about the study participantsThe related't' test analyses for the pre test and post test variable for the numerical pain rating scale and Unpaired 't' test value was shown in figure III.The related 't' value was 12.5 in control group and 18.3 in experimental group and the unrelated 't' value was 13.9.The Tablewasshown in figure III.
SPADIThe related 't' test analyses for the pre test and post test variable for the SPADI and Unpaired 't' test value was shown in table II.The related 't' value was 16.6 in control group and 28.9 in experimental group and the unrelated 't' value was 13.8.Tableisshown in figure IV.
.1.Related 't' test was applied to find the difference between the pre test and post test values where as Unrelated 't' test