In addition to inclusion-exclusion crite- ria, the clinical evaluation included assess- ment of pain, active shoulder external rota- tion and abduction range, forward head posture, mid-thoracic curve, forward shoul- der translation, scapular protraction & rota-
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tion and Pectoralis minor length were done pre and post intervention. It must be noted that the participants were blinded in each block. The patients were treated on different days and unaware of the other group. Also, the examiner who assessed was blinded to group allocation and clinical data. The interventions for both groups were done by two clinicians that were unaware of the treatments groups. One supervised exercise therapy for ET group on even days and the other did phys- ical therapy for PT group on odd days. The power analysis of the study was per- formed to detect a 10% differences in pain and shoulder abduction with α=0/05 and a power of 80%, a sample size of 36 per
group was required. Pain: Subjects were asked to record their maximal pain during the movements based on visual analogue scale (VAS) for pain. The VAS used in the study was a 10-cm line where the 0 was marked as no pain and the 10 as the worst pain imaginable(23). Shoulder Range of Motion (ROM): The ranges of active external rotation and ab- duction were measured by a standard goni- ometer in both symptomatic and asympto- matic shoulders as follows: Shoulder ab- duction was measured in the seated chair position, as in flexion, with the trunk up- right. The arm was actively elevated in the strict coronal plane with the thumb pointed up toward the ceiling to allow the required
Flowchart1. Study profile for participants in ET and PT groups.
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external rotation necessary to avoid im- pingement of the greater tuberosity on the acromion process. Once active end-range was achieved the measurements were doc- umented. Shoulder external rotation was measured in supine with the hips and knees flexed to approximately 45 degrees. The tested arm was supported on the table in 90 degrees of abduction, elbow flexed to 90 degrees, the forearm in midway between pronation/supination and the wrist in neu- tral. A towel roll was placed under the hu- merus to ensure neutral horizontal position- ing; which required the humerus to be level to the acromion process based on visual inspection. Once positioned, the participant was asked to rotate the arm into external rotation to the end available range without discomfort. The participant was instructed not to lift the lower back during this meas- urement. Once active end-range was achieved the measurement was recorded (24).