Short-Term Clinical Comparison of Scapular Stabilization With and Without Added Kinetic-Chain Exercises on Pain, Scapular Kinematics, and Upper-Extremity Function in Overhead Athletes With Subacromial Pain Syndrome: A Randomized Controlled Trial Publisher Pubmed



Chavoshi S S M ; Malmir K ; Otadi K ; Shadmehr A ; Kalantari K K
Source: Physiotherapy Research International Published:2026

Abstract

Background and Purpose: Scapular stabilization exercises are commonly used in the rehabilitation of athletes with subacromial pain syndrome (SAPS) and scapular dyskinesis. Whether supplementing scapular stabilization with kinetic-chain exercises provides greater short-term benefits remains uncertain. This study compared the short-term effects of a scapular stabilization program alone with those of the same program supplemented with additional kinetic-chain exercises. Methods: Twenty-four overhead athletes with SAPS and scapular dyskinesis were randomly assigned to a scapular stabilization group (n = 12) or a kinetic-chain-supplemented group (n = 12). Both groups performed the same standardized scapular stabilization program; the latter also performed additional trunk, lower-extremity, balance, and multisegment exercises, resulting in a greater overall exercise stimulus. Outcomes were assessed before and after 4 weeks. The prespecified primary outcome was scapular upward rotation at 90° shoulder elevation. Between-group differences were analyzed using two-way mixed repeated-measures ANOVA, with the group × time interaction as the principal test, and reported with 95% confidence intervals. Holm–Bonferroni adjustment and baseline-adjusted ANCOVA were conducted as sensitivity analyses. Results: For the prespecified primary outcome, scapular upward rotation at 90°, the group × time interaction was not statistically significant (p = 0.052; ηp2 = 0.161), with a between-group difference in change of −4.38° (95% CI, −8.80° to 0.03°). After Holm–Bonferroni adjustment for the 15 group × time comparisons, the primary outcome remained nonsignificant (adjusted p = 0.723). The baseline-adjusted ANCOVA also showed no statistically significant between-group difference (−3.51°, 95% CI, −7.33° to 0.31°; p = 0.070); however, the significant group × baseline interaction (p = 0.002) indicated that the homogeneity-of-regression-slopes assumption was not met. An unadjusted significant group × time interaction was observed for scapular upward rotation at 45° (p = 0.028), but this finding did not remain significant after Holm–Bonferroni adjustment (adjusted p = 0.426). No other group × time interaction remained statistically significant after adjustment for multiple comparisons. Conclusion: Both rehabilitation programs were associated with short-term improvements in patient-reported outcomes. However, adding kinetic-chain exercises did not result in a clear additional short-term benefit compared with scapular stabilization alone. Because the kinetic-chain group also completed more exercises overall, the specific contribution of the kinetic-chain component cannot be determined. Given the small sample size and uncertainty surrounding the primary outcome, smaller but potentially meaningful differences between the programs cannot be excluded. Trial Registration: IRCT20240614062130N1, registered July 20, 2024. © 2026 John Wiley & Sons Ltd. All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies.