Prone Row Exercise Versus Lateral Pull Down Exercise In Shoulder Impingement Syndrome With Scapular Dyskinesia

Shoulder impingement syndrome (SIS) is a common musculoskeletal disorder, accounting for approximately 44-65% of all shoulder pain complaints. Normal scapular stability includes the ability to keep the scapula's normal position while the arms are at your sides and throughout all upper-limb movements . The upper, middle, and lower trapezius muscles couple with the serratus anterior and rhomboid muscles to form "force couples," which are thought to be important for appropriate scapular orientation.

Scapular dyskinesis occurs when the scapular stabilizing muscles (upper, middle, and lower trapezius, serratus anterior, and latissimus dorsi) are unable to preserve typical scapular movement, and is considered potentially harmful when it results in increased anterior tilting, downward rotation, and protraction, all of which reorient the acromion to reduce the subacromial space width.

Bilateral prone rowing has demonstrated clear clinical benefits for patients with subacromial impingement syndrome. In a four week, supervised program where 16 individuals with stage II SIS performed low rowing three times per week, The Lateral Pull down exercise is widely recognized for its activation of the latissimus dorsi, but it also significantly recruits scapular stabilizers such as the lower trapezius and rhomboids, especially when performed with proper scapular depression and retraction. This makes it an effective exercise for improving scapular muscle strength and control in both healthy individuals and those undergoing shoulder rehabilitation .

Fifty-four male and female patients, with age between 40-65 years (mean age of 52.5 ± 6.25 years) (Yilmaz et al., 2023), will be recruited through direct referrals from orthopedic doctors. They will be asked to sign the informed consent form.

The study will employ a two experimental group protocol. Each group will follow a distinct exercise intervention. Group A will perform the prone row exercise, while Group B will engage in the lateral pull-down exercise. Both groups will also receive selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises . The intervention period will last for 6 weeks, with sessions conducted three times per week under physiotherapist supervision.

Outcome measures:

• Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using handheld dynamometer
• Function using SPADI
• Pain using VAS
• Lateral scapular slide test using Kinovea The results of this study will help determine the most effective exercise approach for improving clinical outcomes in patients with shoulder impingement syndrome and scapular dyskinesia and may provide evidence to guide physical therapy practice.

Inclusion criteria

• -Fifty-four male and female.
• Individuals diagnosed with SIS and aged between 40-65 years with right-hand dominance (Andrea et al., 2024).
• Participants experiencing shoulder pain persisting for a minimum duration of 3 months (Lucas et al., 2022).
• Subjects with a primary complaint of shoulder impingement and scapular dyskinesia according to Neer's classification specifically in stages I and II are referred by an orthopedist (El Melhat et al., 2025).
• Body mass index (BMI) is ≥ 25 kg/m² (Maryam et al., 2023).
• Individuals with a positive Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Kibler, 2003; Odom, 2001).
• All participants must have the cognitive ability to understand instructions and provide informed consent, consistent with standards highlighted in recent informed consent meta-analyses (Tam et al., 2015).

Exclusion criteria

• History of shoulder surgery, dislocation, or fracture (Crawshaw et al., 2010).
• History of neurological disorders (Crawshaw et al., 2010).
• Participants will be excluded if they had cervical spine pain or any signs of cervical radiculopathy (Magee, 2014).
• Individuals with chronic low back pain will be also excluded (Mohamed et al., 2022).
• Pregnant women will be excluded from participation in this study.