Effect of myofascial release on shoulder posture and range of motion in individuals with tetraplegia

1.     BACKGROUND:

Individuals with cervical spinal cord injury (SCI) depend on their upper limbs for mobility, making them highly prevalent to shoulder pain and dysfunction. It arises from altered biomechanics due to wheelchair propulsion, muscle imbalance, and postural changes, often resulting in rounded shoulder posture (RSP) and soft tissue restrictions.

A major factor to shoulder pain and postural dysfunction is pectoralis fascia and muscles tightness. The myofascial release (MFR) has been shown to reduce fascial restrictions, improve posture, range of motion (ROM), function and spasticity in neurological conditions like stroke, multiple sclerosis and cerebral palsy.

The role of MFR in individuals with tetraplegia in improving rounded shoulder posture, anterior chest tightness and ROM is underexplored. The results of the present study will help in formulating a comprehensive physiotherapy plan for shoulder range and rounded shoulder posture in individuals with tetraplegia.

2. OBJECTIVES

·       To find out the effect of myofascial release on Posture (Rounded/Forward Shoulder Angle) in individuals with tetraplegia

·       To evaluate the effect of myofascial release on Function (Shoulder Pain and Disability Index) in individuals with tetraplegia

·       To evaluate the effect of myofascial release on Passive Range of Motion (Universal Goniometer) in individuals with tetraplegia

3. HYPOTHESIS

Null Hypothesis Ho-

•        There is no significant difference in effect of myofascial release (MFR) combined with conventional physiotherapy versus sham MFR combined with conventional physiotherapy on posture, function and PROM in individuals with tetraplegia.

Alternate Hypothesis H1-

•        There is a significant difference in effect of MFR combined with conventional physiotherapy versus sham MFR combined with conventional physiotherapy on posture, function and PROM in individuals with tetraplegia.

4. MATERIAL AND METHODS

This randomized controlled trial will be conducted on tetraplegic patients with rounded shoulder posture and restricted range of motion of shoulder, recruited from the Indian Spinal Injury Centre, New Delhi. A total of 20 participants (10 in each group) will be included based on strict inclusion and exclusion criteria. Eligible individuals will be aged 18–60 years, diagnosed with paraplegia (C5–C8) level. Participants with history of trauma or surgery, diagnosed with inflammatory disorders, adhesive capsulitis and joint instability, analgesic use, or cognitive issues will be excluded.

Baseline assessments will cover posture (Rounded/Forward Shoulder Angle measured via photography using MB-Ruler-freeware for screen-based angle and distance measurement), functional limitation (Shoulder Pain and Disability Index-SPADI) and PROM (goniometry). Participants will be randomly assigned into a control group (sham MFR + conventional physical therapy) and an experimental group (MFR + conventional therapy). The intervention will be conducted for 40 minutes per session, five times a week for two weeks. Post-intervention assessments will follow the same outcome measures.

5.  STATISTICAL ANALYSIS PLAN:

Data will be analysed using SPSS v21.0. Normality will be tested with the Shapiro-Wilk test. Paired t-test or Wilcoxon test will be used for within-group comparisons, and independent t-test or Mann–Whitney U test for between-group comparisons.