Authors :
Dr. Aveek Nandy; Dr. Paramita Biswas; Dr. Sourav Mitra
Volume/Issue :
ICVDRS 2026
Google Scholar :
https://tinyurl.com/mwmhn35f
Scribd :
https://tinyurl.com/yvmp6m3t
DOI :
https://doi.org/10.38124/ijisrt/26jun1601
Abstract :
Background:
Rotator Cuff Related Shoulder Pain (RCRSP) is a leading cause of upper limb disability. While general exercise is
effective, recalcitrant cases often involve underlying scapular dyskinesis and fear-avoidance behaviours. This study explores
the efficacy of a tailored, progressive loading protocol combined with scapular motor control training.
Case Presentation:
A 45-year-old male landscape gardener presented with an 8-month history of right dominant shoulder pain (NPRS
7/10). The pain was primarily localized to the lateral deltoid and exacerbated by overhead reaching and lifting. Clinical
examination revealed a positive Hawkins-Kennedy test, painful arc between 70°–120°, and obvious "winging" of the medial
scapular border during eccentric lowering (Scapular Dyskinesis Type II). Initial Disability of the Arm, Shoulder, and Hand
(DASH) score was 48.2.
Result:
The patient underwent a 10-week, 3-phase physiotherapy program. Phase 1 (Weeks 1-2) focused on pain modulation
and scapular "setting" exercises (serratus anterior and lower trapezius activation). Phase 2 (Weeks 3-6) introduced isotonic
rotator cuff strengthening using resistance bands and dumbbells, emphasizing eccentric control. Phase 3 (Weeks 7-10)
transitioned to heavy slow resistance (HSR) training and sport-specific plyometric reaching tasks to build tissue resilience.
Pain neuroscience education was integrated throughout to address fear-avoidance regarding overhead movement. At the
10-week follow-up, the patient reported an NPRS of 1/10. The DASH score improved significantly to 12.5, surpassing the
Minimal Clinically Important Difference (MCID). Objective testing showed a 40% increase in shoulder abduction strength
and normalized scapulohumeral rhythm. Most importantly, the patient returned to full-time gardening duties without
activity modification.
Conclusion:
This case demonstrates that a structured, phase-based loading program that specifically addresses scapular kinematics
and patient education can lead to superior functional outcomes in chronic RCRSP compared to generic exercise or passive
modalities.
Keywords :
Shoulder Pain, Rotator Cuff Pain, Scapular Dyskinesia Correction, Rotator Cuff-Related Shoulder Pain.
Background:
Rotator Cuff Related Shoulder Pain (RCRSP) is a leading cause of upper limb disability. While general exercise is
effective, recalcitrant cases often involve underlying scapular dyskinesis and fear-avoidance behaviours. This study explores
the efficacy of a tailored, progressive loading protocol combined with scapular motor control training.
Case Presentation:
A 45-year-old male landscape gardener presented with an 8-month history of right dominant shoulder pain (NPRS
7/10). The pain was primarily localized to the lateral deltoid and exacerbated by overhead reaching and lifting. Clinical
examination revealed a positive Hawkins-Kennedy test, painful arc between 70°–120°, and obvious "winging" of the medial
scapular border during eccentric lowering (Scapular Dyskinesis Type II). Initial Disability of the Arm, Shoulder, and Hand
(DASH) score was 48.2.
Result:
The patient underwent a 10-week, 3-phase physiotherapy program. Phase 1 (Weeks 1-2) focused on pain modulation
and scapular "setting" exercises (serratus anterior and lower trapezius activation). Phase 2 (Weeks 3-6) introduced isotonic
rotator cuff strengthening using resistance bands and dumbbells, emphasizing eccentric control. Phase 3 (Weeks 7-10)
transitioned to heavy slow resistance (HSR) training and sport-specific plyometric reaching tasks to build tissue resilience.
Pain neuroscience education was integrated throughout to address fear-avoidance regarding overhead movement. At the
10-week follow-up, the patient reported an NPRS of 1/10. The DASH score improved significantly to 12.5, surpassing the
Minimal Clinically Important Difference (MCID). Objective testing showed a 40% increase in shoulder abduction strength
and normalized scapulohumeral rhythm. Most importantly, the patient returned to full-time gardening duties without
activity modification.
Conclusion:
This case demonstrates that a structured, phase-based loading program that specifically addresses scapular kinematics
and patient education can lead to superior functional outcomes in chronic RCRSP compared to generic exercise or passive
modalities.
Keywords :
Shoulder Pain, Rotator Cuff Pain, Scapular Dyskinesia Correction, Rotator Cuff-Related Shoulder Pain.
