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● JOURNAL
OF PUBLIC
HEALTH,
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AND MEDICAL
RESCUE
● No.●1/2015
(65-72)
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65
Assessment of the influence of selected kinesitherapeutic methods on the function of the
shoulder girdle in patients with the shoulder
impingement syndrome
(Ocena wpływu wybranych metod kinezyterapeutycznych na funkcję obręczy barkowej u pacjentów z zespołem bolesnego barku)
I Rotter 1,A,D, H Mosiejczuk 1,C, J Żugaj 2,B, M Ptak 1,E, A Lubińska 1,F
Abstract - Introduction. The shoulder impingement syndrome
is a frequent musculoskeletal disease and kinesitherapy is a
crucial element in the treatment of the disease.
Aim of the study. A comparison of the effectiveness of the PNF
method and traditional kinesitherapy in the treatment of patients with the shoulder impingement syndrome in order to
reduce pain, increase the range of motion in the shoulder joint
and improve muscle strength.
Materials and methods. The research was conducted in 2012
and 2013 in a physiotherapy clinic. The study group consisted
of 60 people, both male and female, aged 54 on average, diagnosed with the shoulder impingement syndrome. The patients
were divided into two groups of 30 – the first group was treated with a PNF method, and the second group was treated using
standard kinesitherapy techniques. Both groups were tested
before and after a series of rehabilitation. An anonymous questionnaire created by the researcher was the main research
method. In order to assess pain, an 11-degree visual analogue
scale (VAS) was used, the range of motion was measured by a
goniometer, muscle strength was assessed using the Lovett test
and an assessment of the deltoid muscle mass was conducted
using an arm circumference measurement or R1 short arm. The
results of the trial were then statistically verified.
Results. The use of kinesitherapy methods resulted in an increased range of shoulder motion, enhanced muscle strength of
the shoulder, pain reduction, and a smaller number of patients
suffering from deltoid muscle atrophy.
Conclusion. The use of kinesitherapy methods has a beneficial
influence on the effectiveness of the treatment in the shoulder
impingement syndrome.
Key words - shoulder impingement syndrome, PNF method,
standard kinesitherapy techniques.
Streszczenie – Wstęp. Zespół bolesnego barku jest często
występującą chorobą narządu ruchu a zastosowanie kinezyter-
apii w jest bardzo ważnym elementem w procesie leczenia tego
schorzenia.
Cel pracy. Porównanie skuteczności metody PNF oraz klasycznej kinezyterapii w leczeniu osób z zespołem bolesnego
barku w celu zmniejszenia dolegliwości bólowych, zwiększenia
zakresu ruchu w stawie ramiennym oraz zwiększenia siły
mięśniowej.
Materiał i metody badań. Badania prowadzono w latach 20122013. Grupa badana składała się z 60 osób z rozpoznanym
zespołem bolesnego barku obojga płci, średnia wieku 54 lata.
Pacjenci zostali podzieleni na dwie grupy 30 osobowe.
Pierwsza grupa została poddana rehabilitacji terapią PNF, a
druga grupa była rehabilitowana za pomocą standardowych
technik kinezyterapeutycznych. Obie grupy zostały poddane
badaniom przed i po serii rehabilitacyjnej. Metodą badawczą
był autorski anonimowy kwestionariusz ankiety. W celu oceny
skali bólu posłużono się 11-stopniową skalę wizualno analogową VAS, goniometrem przeprowadzono pomiary zakresu
ruchu w stawie ramiennym, testem Lovetta oceniono siłę
mięśni oraz dokonano oceny masy mięśnia naramiennego
wykorzystując pomiar obwodu ramienia taśmą centymetrową
czyli R1 krótki ramienia. Uzyskane wyniki poddano analizie
statystycznej.
Wyniki.
Zastosowanie metod kinezyterapeutycznych
spowodowało: zwiększenie zakresu ruchomości stawu ramiennego, przyrost siły mięśni stawu ramiennego, zmniejszenie
dolegliwości bólowych, zmniejszenie ilości osób u których
występowały zaniki mięśnia naramiennego.
Wnioski. Zastosowanie metod kinezyterapeutycznych wykazuje korzystny wpływ na skuteczność leczenia zespołu bolesnego
barku.
Słowa kluczowe - zespół bolesnego barku, metoda PNF, standardowe techniki kinezyterapii.
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Author Affiliations:
1. Independent Laboratory of Rehabilitation Medicine
2. Students Scientific Association, Independent Laboratory of
Rehabilitation Medicine
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Hanna Mosiejczuk, Independent Laboratory of Rehabilitation
Medicine, Pomeranian Medical University in Szczecin
Grudziądzka 31 Str., PL-71 – 210 Szczecin, email: [email protected]
Accepted for publication: December 11, 2014.
I. INTRODUCTION
he shoulder impingement syndrome is a collection of
various ailments disturbing the proper function of the
pectoral girdle. It is an ever more frequent condition
of the musculoskeletal system requiring relevant treatment and rehabilitation [1,2,3,4,5,6,7]. The most frequent endogenous causes of this condition include: damage of rotator cuff tendons, shoulder synovitis, shoulder
tightness, joint instability, overload and micro damage of
soft tissue, fractures, local inflammation of the synovial
membrane leading to the gluing and symphysis of the
lower recess, calcium deposits or ossification of distal
muscle tendons, capsulitis, and degenerative changes.
Although the causes may be various, the most frequently
indicated one is pathological changes in the supraspinatus. External factors include: damage of the brachial
plexus, pressure neuropathies, changes in the intervertebral discs, and degenerative cervical spine disorders
[2,8,9,10,11,12,13]. For a complete diagnosis of the condition, specialist theoretical and practical knowledge is
necessary; moreover, much attention is paid to the patient’s complaints [14,15,16]. The first symptom in the
shoulder impingement syndrome is pain which imposes a
limited mobility on the upper limb, especially in terms of
abduction and rotation, but also flexion. Usually, active
T
66
movement of the humeral head is lost and proprioceptive
dysfunction occurs. The ailments become worse and lead
to a non-physiological position of the upper limb, in
which the shoulder is dropped and rotated inwards, the
elbow flexed, and the limb adduced close to the chest.
The pain felt by the patient often radiates toward the outer part of the shoulder or towards the neck and shoulder
blade. In the course of the illness, muscle strength of the
upper limb is weakened, and frequently muscle atrophy
occurs in the shoulder and shoulder blade [5,17,
18,19,20,21,22].
Treatment and rehabilitation should be implemented as
quickly as possible to counter the shoulder impingement
syndrome. There are many surgical and non-surgical
methods of treating the disease in question. Surgical
methods are typically used in the event of rotator cuff
tear. The various non-surgical methods must be used
carefully and at an appropriate time. At the severe stage
of the illness, pain is treated usually by pharmacotherapy
and physical therapy. Once the pain-alleviating effect has
been achieved, kinesitherapy must be incorporated into
treatment as soon as possible. Physical exercise is of vast
importance, especially because it helps maintain an appropriate range of mobility as well as muscle strength; it
positively influences local blood flow and the biological
condition of affected tissue. Well-balanced kinesitherapy
also alleviates pain because it prevents further pathological change and mobility restraints, and it levels muscular
tension which is often increased in the painful muscles
[9, 23,24,25,26,27,28,29].
From various rehabilitation methods in the shoulder impingement syndrome, the following are often used:
 traditional rehabilitation using basic techniques such
as non-weight-bearing exercise and self-assisted exercise
 special kinesitherapeutic methods such as: the PNF
method, manual therapy, the Cyriax method, osteopathic methods, and post-isometric relaxation. The
selection of methods depends mostly on the physiotherapist [30,31].
Non-weight-bearing exercise and self-assisted exercise, i.e. traditional kinesitherapy, are most frequently
applied to patients who cannot make an active movement
in a full range. [32,33] The purpose of such exercise is to
increase the range of mobility, relax tense muscles,
strengthen the muscles, and prevent contractures or muscular atrophy in the exercised area. Moreover, the activation of muscle groups improves tissue nutrition, flexibility and proprioceptive facilitation. These exercises are
usually done in universal exercise units consisting of
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suspensions, ropes and direction pulleys or using an exercise stick.
The PNF method (Proprioceptive Neuromuscular Facilitation) was developed in the 1940s. The underlying
assumption is that brain plasticity may be used to fully
activate the receptors involved in locomotor activity.
PNF therapy is aimed at enhancing the patient’s functionality as much as possible with the use of techniques
employing the healthy parts of the body. Objectives are
met by applying movement patterns, executing these patterns in diagonal planes and accenting rotation elements
in these planes. The therapist selects techniques in accordance with the therapeutic objective. PNF therapy is
considered an effective method of work with patients
suffering from locomotor disorders, including patients
with the shoulder impingement syndrome. PNF techniques improve muscle strength, enhance the mobility
range, increase the durability of musculoskeletal structures, and foster coordination. They also release tension
and alleviate pain [29,30,34,35,36].
Due to the large number of kinesitherapeutic methods,
this study evaluates the influence of selected
kinesitherapeutic techniques on the function of the
pectoral girdle in patients with the shoulder impingement
syndrome. The authors have attempted to assess the
effectiveness of these methods on alleviating pain,
decreasing muscular atrophy in the pectoral girdle,
increasing joint mobility and muscle strength.
II. MATERIALS AND METHODS
Material
The study was conducted in 2012 and 2013. The study
group comprised 60 patients, both male and female aged
54 on average, diagnosed with the shoulder impingement
syndrome. The patients were divided into two groups, 30
members in each. The first group (A) was subjected to
rehabilitation using PNF methods; the second group (B)
was rehabilitated using standard kinesitherapeutic techniques such as non-weight-bearing exercise and selfassisted exercise. Both groups were tested before and
after a series of rehabilitation. In group A, women constituted 40% and 43.33% in group B. As many as
38.33% of the respondents in both groups had experienced pain for longer than 6 months, 36.67% for 3 to 6
months; pain lasting shorter than 3 months was reported
by 13.33% of respondents, whereas 11.67% patients has
experienced pain for about 12 months.
67
Methods
The research method was an original survey questionnaire designed to obtain information regarding the occurrence and type of pain. The respondents could select
multiple painful symptoms affecting them before and
after therapy. In order to assess pain, an 11-degree visual
analogue scale (VAS) was used. The patients marked on
a 10-centimetre scale the subjective perception of pain
before and after therapy. The results were measured by
the therapist using a ruler and provided in millimetres
[37]. A goniometer was used to measure the active and
passive mobility range of the shoulder joint: elevation by
flexion, elevation by abduction, extension, external and
internal rotation [38,39.] The Lovett test was used to
assess the strength of the muscles performing the following functions in relation to the shoulder joint: flexion,
extension, abduction, rotation outside, and rotation outside. The results have been presented in points. For load
reduction during the study, an axial suspension system in
the universal exercise unit was used. Incomplete and
complete resistance was determined consistently with the
study method in relation to the healthy limb [38,39,40].
Statistical methods
The results obtained were analysed statistically. Statistica
8.0 software was used for calculations. The following
were used in the statistical analysis: the arithmetic mean,
standard deviation, coefficient of variation as well as the
minimum and maximum values in the samples. In order
to verify the significance between the means, Student’s ttest was applied. The significance level at which research
problems were verified had been adopted to be the value
of 0.05.[41,42]
III. RESULTS
Before rehabilitation began, patients from group A had
most frequently reported the occurrence of pain at night
during sleep (56.67%) and when performing abrupt
movements of the upper limb (56.67%), whereas respondents in group B had most frequently complained
about pain at night (53.33%), pain while performing activities related to hygiene (50%) and during abrupt
movements (53.33%). Following rehabilitation, in group
A there was a decrease in the number of reported activities which brought about pain of the upper limb. A complete lack of pain was indicated by 26.67% of respondents. None of the patients experienced pain in static posi-
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tions. The largest number of people (46.67%) complained of pain during abrupt movements. Similarly,
group B reported fewer activities triggering pain in the
upper limb following rehabilitation. A complete lack of
pain was indicated by 10% of patients. The number of
patients complaining of pain in static positions did not
decrease (10%). In the analysis of the decrease in the
number of activities causing pain reported by patients, a
larger improvement was observable in group A than in
group B. A statistically significant difference was observed in terms of pain decrease for both groups before
and after rehabilitation (A - p≤0.00000; B - p≤
0.000528). (Fig. 1, Table 1)
BeforerehabilirehabiliBefore
tation
Przed
rehabilitacją
tation
80
70
mm
Before rehabilitation, both groups included cases of deltoid muscle atrophy in comparison to the healthy limb.
When comparing the mass of the deltoid muscle to the
healthy limb in group A, 60.67% of respondents were in
the normal range whereas muscular atrophy affected
33.33% of them. In group B, 70% of respondents had a
normal deltoid muscle and deltoid muscle atrophy was
observable in 30% of patients. Once rehabilitation had
been completed, both study groups evinced a smaller
percentage of deltoid muscle atrophy cases. The group
rehabilitated with the PNF method (A) showed better
improvement than the group subjected to traditional
methods. (Table 2)
Table 2. Results of the analysis of deltoid muscle atrophy
After
rehabilitaAfter
rehabilita-
Po rehabilitacji
tiontion
Deltoid muscle atrophy
68,57
61,97
56,17
60
50
68
Before rehabilitation
After rehabilitation
46,4
a
– normal
muscle
mass in
comparison
to the
healthy
limb
b
- muscular
atrophy in
comparison
to the
healthy
limb
a
– normal
muscle
mass in
comparison
to the
healthy
limb
b
- muscular
atrophy in
comparison
to the
healthy
limb
n
20
10
27
3
%
66.67
33.33
90
10
n
21
9
23
7
%
70
30
76.67
23.33
40
30
group
20
10
0
Grupa AA
Group
Grupa B
B
Group
A
Figure 1. Subjective evaluation of pain by patients in
groups A and B before and after rehabilitation
B
Table 1. Subjective evaluation of pain by patients in
groups A and B before and after rehabilitation
Evaluation of pain –VAS scale in mm
group
examination
n
X
Before rehabilitation
30
68.57
A
B
p
0.00000
After rehabilitation
30
46.40
Before rehabilitation
30
61.97
30
56.17
After rehabilitation
0.000528
In both groups, before and after rehabilitation, a statistically significant improvement has been observed in
terms of active and passive mobility of the shoulder joint.
(Table 3)
p
0,000000
Active
range
0,000400
48,83
x
62,07
Passive
range
46,57
0,000001
39,77
External rotation
51,63
54,03
p
0,000306
37,00
x
43,07
0.000002
42.47
p
0.001621
54.97
x
43.97
Active
range
48.47
p
0.000001
Passive
range
0.000611
35.43
x
47.93
p
33.97
Extension
39.37
x
0.000015
Active
range
0.000146
p
39.33
x
46.13
x
39.93
x
0.000009
30.20
Elevation by abduction
42.63
36.17
0.000013
88.03
x
0.000234
28.87
105.67
Passive
range
31.13
0.001590
83.43
0.000000
77.83
Active
range
p
91.83
97.57
0.000001
109.37
Passive
range
p
0.000459
73.40
131.03
Elevation by flexion
81.80
0.000516
113.50
A
0.000000
30
99.63
examination
Active
range
p
118.77
0.000156
30
30
103.07
30
109.13
Before rehabilitation
n
123.60
After rehabilitation
Before rehabilitation
B
After rehabilitation
group
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Table 3. Results of the analysis of movement range in the shoulder joint
Analysis of changes in movement range of the shoulder joint
Internal rotation
Passive
range
x
p
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In both groups, a statistically significant improvement
of flexion muscle strength, extension and abduction was
observed; yet only in group A did external and internal
rotation improve after rehabilitation, unlike in the group
following the traditional methods. (Table 4)
Table 4. Results of the analysis of muscle strength
change
p
p
0.000042
0.057307
1.43
2.03
0.001135
1.60
1.47
0.103300
1.33
1.70
0.000000
2.50
x
1.37
x
0.008904
2.23
3.13
0.000007
2.40
p
1.33
x
0.017372
2.10
3.10
0.000000
B
p
2.27
x
0.002939
2.83
3.10
3.80
30
30
30
Before rehabilitation
After rehabilitation
After rehabilitation
p
2.27
x
2.73
30
group
n
A
Before rehabilitation
examination
Analysis of muscle strength change in the shoulder joint
FlexExtenAbducExternal Internal
ion
sion
tion
rotation
rotation
IV. DISCUSSION
The shoulder impingement syndrome is becoming an
ever more frequent disorder these days. It usually affects
the elderly, but also professionally active individuals and
athletes. Therefore, the disorder is an obstacle to both
professional life and physical activity of people of any
age, regardless of their profession. The condition is usually caused by overloading the upper limb, which leads
to micro damage and degeneration of the pectoral girdle
[2,3,6,7,14,15,24].
Effective treatment and rehabilitation of the shoulder
impingement syndrome is the subject of study for both
doctors and physiotherapists.
The results presented demonstrate that the application
of kinesitherapy improves the mobility range and muscle
70
strength of the shoulder joint and it contributes to the
reduction of muscular atrophy and pain among the patients. The group subjected to PNF therapy has demonstrated much better results than the group rehabilitated in
a standard manner. The results of the present study confirm the study conducted in 2005 at the University
School of Physical Education in Wrocław by Sipko et al.
The purpose of their research was to create an effective
rehabilitation programme for the shoulder impingement
syndrome using the PNF method. They observed improvement in the mobility range and a reduction in pain
among the patients as well as an overall beneficial influence of the PNF method on the rehabilitation of patients
suffering from the shoulder impingement syndrome [30].
Kokosz et al compared Mulligan’s manual therapy to
the standard kinesitherapeutic methods. The purpose of
their study was to compare the direct and short-term effects of movement on the extent of pain experience by
patients and on the mobility range of the pectoral girdle.
They proved a greater improvement of the mobility range
and a more significant reduction of pain in patients treated using Mulligan’s method in comparison to the control
group .[43]
Buczek et al based in Bydgoszcz undertook to study
the effectiveness of post-isometric relaxation (PIR) in
rehabilitation of the shoulder impingement syndrome. In
the final examination, a group subjected to a series of
kinesitherapy and physiotherapy and a second group additionally treated with PIR obtained similar results. The
post-isometric relaxation method did not prove to be
more effective in the rehabilitation of shoulder impingement patients than the standard physiotherapy methods
[44]. Presumably, as the authors observe, the PIR method
may have been too difficult for patients to follow.
Numerous studies have evaluated the influence of kinesitherapy combined with physical therapy on the
treatment of the shoulder impingement syndrome.
Krukowska [45] and Piechura [46] have investigated the
influence of local cryotherapy combined with standard
kinesitherapy methods on the results of physical therapy
of patients with the shoulder impingement syndrome.
The studies have shown that kinesitherapy has a beneficial influence on the rehabilitation of the upper limb,
whereas the application of cryotherapy alleviates pain.
Lisiński and Grabarczyk [47] used a therapy consisting of lignocaine iontophoresis, medium-frequency current therapy and kinesitherapy, which depending on the
indication involved standard exercise techniques and
PNF methods. Subsequently, the respondents were divided into two groups: one was subjected to a local cryo-
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therapy treatment using nitrogen steam, whereas the
other group was treated using a Sollux lamp with a red
filtre. As a result, the mobility range and muscle strength
were improved in both groups. It has not been demonstrated, however, which physical treatment was more
effective. The above-mentioned research points to a positive influence of kinesitherapy on the rehabilitation of
patients suffering from the shoulder impingement syndrome. Studies suggest that special methods such as the
PNF and Mulligan’s method are more effective than the
traditional ones. This definitely results from the fact that
the special methods are based on an individual, precise
cooperation of the therapist with the patient.
The application of physiotherapeutic methods and
their combination with kinesitherapy in the treatment of
the shoulder impingement syndrome is a contentious
issue for various researchers. Some therapists focus on
kinesitherapy, believing it to be the most important part
of the rehabilitation of shoulder impingement syndrome
patients. The standard procedure in the treatment of this
condition is traditional kinesitherapy. It is currently being
extended with special methods which often evince a
higher effectiveness upon examination.
In all of the studies referred to, the researchers emphasise the necessity of a more detailed diagnosis of patients
suffering from the shoulder impingement syndrome. The
general diagnosis of the shoulder impingement syndrome
with which patients are directed to a physiotherapist
should be complemented by specifying the cause of the
disorder and supported by additional examinations, such
as ultrasonography. Failure to specify the reason for the
condition often results in problems with choosing a relevant type of physiotherapy, which prolongs the process
of rehabilitation. It is advisable to extend the diagnostic
methods related to this disorder to enable a precise and
effective rehabilitation excluding the root of the disorder
and not only the symptoms. Kinesitherapy is an indispensable element of treating the shoulder impingement syndrome. It is therefore reasonable to conduct research on
the effectiveness of kinesitherapeutic methods in rehabilitating patients with the shoulder impingement syndrome so that comprehensive rehabilitation programmes
are created adapted to the individual needs of patients.
V. CONCLUSION
1. The application of kinesitherapeutic methods has a
beneficial influence on increasing the mobility
range of the shoulder joint, enhancing muscle
strength of the shoulder joint, alleviating pain, and
71
decreasing the number of patients with deltoid muscle atrophy.
2. The PNF method is more effective in improving the
functionality of the upper limb in shoulder impingement syndrome patients than traditional kinesitherapeutic methods.
.
VI. REFERENCES
[1] Dziak A, Serafin- Król M, Kintzi M, Czamara A,
Gawroński W. Rehabilitacja w uszkodzeniach stawu
barkowego. Kraków; Wydawnictwo Med Sportiva,
2003.
[2] Buckup K. Testy kliniczne w badaniu kości, stawów i
mięśni. Warszawa; Wydawnictwo PZWL, 1997.
[3] Łyp M, Maciak W, Cabak A, Ogonowski A. Zmiany
zwyrodnieniowe stawu barkowo- obojczykowego a
zespół bolesnego barku. Fizjoter Pol 2006; 1, 4: 5157.
[4] Van der Windt DA, Koes B. et al. Shoulder disorders
in general practice: incidence, patient’s characteristic
and management. Ann Rheum 1995; 10, 54: 959964.
[5] Dziak A. Bolesny bark jako następstwo wad
wrodzonych, urazów, eksploatacji podczas uprawiania sportu i w pracy zawodowej oraz zmian wstecznych
i chorobowych zespołów tkankowych i narządowych.
Med Sportiva 2003; 7(2): 81-92.
[6] Lauterbach G. Rehabilitacja barku sportowca. Med
Sportiva 1998; vol.2, no.3:21-26.
[7] Dziak A, Tayara SH. Bolesny bark. Kraków;
Wydawnictwo Kasper, 1998.
[8] Jens Ivar Brox, Ból barku. Med Prakt Chir 2005; 3:1832.
[9] Dutka J, Sosin P. Leczenie ortopedyczne zespołu
bolesnego barku. Rehabil Med 2004; Tom 8, 2: 2635.
[10] Nowotnego J. (red.) Podstawy kliniczne fizjoterapii
w dysfunkcjach narządu ruchu. Warszawa;
Wydawnictwo Medipage, 2006.
[11] Pogorzelec P. Zastosowanie metody Kinesio Taping
w terapii wybranych urazów stawu barkowego. Rehabil Prakt 2012; 5: 36.
[12] Lesiak A. Ocena dysfunkcji obręczy barkowej w badaniu pacjentów z zespołem bolesnego barku. Rehabil Med 2002; 6 ( nr specjalny): 20-25.
[13] Kolster B. Ebelt- Paprotny G. Poradnik fizjoterapeuty. Wrocław; Wydawnictwo ,,Ossolineum”, 1995.
[14] Jens Ivar Brox. Ból barku. Med Prakt Chir
2005;3:18-32.
[15] Tayara SH. Kinezyterapia i sposoby fizykoterapii w
zespole bolesnego barku. Med Sport 2001; 2 115:
12-16.
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[16] Solem Berlot E. Zespół bolesnego barku z punktu
widzenia fizjoterapeutycznego- przegląd literatury.
Rehabil Med 2002; 6:10-17.
[17] Wiktora Degi. Ortopedia i Rehabilitacja. Warszawa;
Wydawnictwo Lekarskie PZWL, 2003.
[18] Skalska I, Śliwiński Z. Zespół bolesnego barku w
aspekcie zespołu przeciążeniowego mięśni rotatorów.
Polish Sports Med 2002; 18(12):513-518.
[19] Samborski W. Terapia zespołów bólowych z grupy
reumatyzmu tkanek miękkich. Przew Lek 2007; 3:
51-54.
[20] Kiwerski J. Rehabilitacja medyczna. Warszawa;
Wydawnictwo Lekarskie PZWL, 2006.
[21] Bigliani LU, Levine WN, Curent concept review.
Subacromial impingement syndrome. J Bone Joint
Surg 1997; 79A: 1854-68.
[22] Kessel L, Watson M, The painful arc syndrome.
Clinical classification as a guide to management. J
Bone Joint Surg 1997; 59B(2): 166-72.
[23] Hanger- Derengowska M. i wsp. Kompleksowość i
różnorodność procesu rehabilitacji w przypadłości
współczesnego człowieka, czyli zespół bolesnego
barku. Fam Med Primary Care Rev 2009; 3: 611615.
[24] Szapel K. Zespół bolesnego barku- diagnostyka i terapia. Warszawa; Wydawnictwo Young Therapist,
2007.
[25] Szelest M, Dymarek R, Ptaszkowski K, Słupska L,
Felińczak A. Porównanie poziomu wiedzy na temat
zespołu bolesnego barku wśród studentów fizjoterapii Akademii Medycznej i Akademii Wychowania
Fizycznego we Wrocławiu. Piel Zdr Publ 2012;
2,1:15-28.
[26] Berfort SE. Zespół bolesnego barku z punktu
widzenia fizjoterapeutycznego-przegląd literatury.
Rehabil Med 2002; 6:52-78.
[27] Lesiak A. Zespół bolesnego barku- patogeneza, obraz
kliniczny i leczenie, Rehabil Med 2002; 6: 26-41.
[28] Zembatego A. Kinezyterapia. Kraków; Wydawnictwo KASPER, 2002.
[29] Sipko T, Mraz M, Demczuk- Włodarczyk E, Miażdżyk M. Próba zastosowania metody PNF w terapii
zespołu bolesnego barku. Fizjoter Pol 2005;1: 41-47.
[30] Rasławski A, Skolimowski T. Technika Wykonywania Ćwiczeń Leczniczych. Warszawa; Wydawnictwo
Lekarskie PZWL, 2007.
[31] Bienias- Jędrzejewska M, Wrzosek Z. Przydatność
krioterapii w leczeniu zespołu bolesnego barku.
Fizjoterapia 1994; 2: 3-6.
[32] Szczegielniak J. Wpływ elektrostymulacji na
poprawę ruchomości stawu barkowego u chorych z
zespołem bolesnego barku., Fizjoterapia; 1996; 4:3,
6-7.
[33] Kokosz M i wsp. Możliwość wykorzystania stymulacji oraz technik specjalnych w metodzie PNF.
Fizjoterapia 1998; 2:12-17.
72
[34] Kwolka A. Rehabilitacja medyczna. Wrocław;
Wydawnictwo Urban & Partner, 2003.
[35] Jaruga M, Manikowski W, Romanowski L, Lubiatowski P, Spławski R, Jaruga M. Zasady
postępowania usprawniającego przed i pooperacyjnego w leczeniu artroskopowym dolegliwości
bólowych
barku.
Ortop Traumatol Rehab
2003;4:469-474.
[36] Krajewska- Kułake, Szczcepański M. Badanie
fizykalne w praktyce pielęgniarek i położnych. Lublin; Wydawnictwo CZELEJ, 2008.
[37] Skolimowskiego T. Badania czynnościowe narządu
ruchu w fizjoterapii. Wrocław; Wydawnictwo AWF
Wrocław, 2009.
[38] Zembatego A. Kinezyterpia. Kraków; Wydawnictwo.
KASPER, 2002.
[39] Paprocka- Borowicz M, Zawadzki M. Fizjoterapia w
chorobach układu ruchu. Wrocław; Górnicki
Wydawnictwo Medyczne, 2010.
[40] Bedyńska S, Brzezicka A. (red.). Statystyczny
drogowskaz. Praktyczny poradnik analizy danych w
naukach społecznych na przykładach z psychologii.Warszawa; Wydawnictwo SWPS Academica, 2007.
[41] Moczko JA, Bręborowicz G H, Tadusiewicz R. Statystyka w badaniach medycznych. . Warszawa;
Wydawnictwo Springer PWN, 1998.
[42] Kokosz M, Sodel W, Saulicz E, Wolny T, Knapik A.
Bezpośrednie
i krótkoterminowe efekty mobilizacji z ruchem
według B. Mulligana, wykonywanych u pacjentów z
niespecyficznymi dolegliwościami przeciążeniowobólowymi obręczy barkowej. Fizjoter Pol 2009;4
(4):301-311.
[43] Buczek N, Dzierżanowski N, Hanger W, Rutyna A.
Wpływ poizometrycznej relaksacji mięśniowej na
leczenie przykurczy pochodzenia mięśniowego i stawowego w zespole bolesnego barku. Kwart Ortop
2007;1:22-25.
[44] Krukowska J, Zbrzezna J, Czernicki J. Wpływ krioterapii na wyniki fizjoterapii chorych z zespołem
bolesnego barku. Fizjoterapia 2009;4:19-27.
[45] Piechura J, Skrzek A, Rożek K, Wróbel E. Zastosowanie zabiegów krioterapii miejscowej w terapii
osób z zespołem bolesnego barku. Fizjoterapia
2010;1:19-25.
[46] Lisiński P, Grabarczyk G. Aspekty fizjoterapii w leczeniu zaburzeń czynności stawu ramiennego. Chir
Narz Ruchu 2005;70 (4):295-299.