Kurtaran, U., Yerlikaya, T., Yenen, B., & Özgül, A. (2025). The Effect of Humeral Head Depressor Strengthening on Individuals with Subacromial Impingement Syndrome. Medicina, 61(11), 2061.
In a study involving Res. Asst. Utku Kurtaran and Assoc. Prof. Dr. Tuba Yerlikaya from Near East University (NEU), Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, and Prof. Dr. Ahmet Özgül from the Department of Physical Medicine and Rehabilitation, Girne University, the research team investigated whether adding a more targeted strengthening approach can improve recovery for people with subacromial impingement/subacromial pain syndrome—one of the most common causes of shoulder pain, often felt during reaching or overhead activities.
Participants followed a 6-week rehabilitation program in outpatient clinic of the Department of Physical Medicine Rehabilitation. One group received standard physiotherapy, while the other group completed a combined, progressive exercise plan that also focused on strengthening the shoulder muscles to enlarge narrowed subacromial space and keep it in ordinary anatomic position, together with scapular stabilization and proprioceptive training. Outcomes were tracked using ultrasound (to measure the space under the acromion and tendon thickness) as well as pain and function questionnaires.
Both groups improved, but the combined exercise group showed a greater increase in the subacromial space—the acromio–humeral distance rose from 7.92 mm to 10.54 mm, compared with 7.72 mm to 8.41 mm in the standard-care group. In everyday terms, this larger improvement was accompanied by stronger reductions in pain, better upper-limb function, and a more noticeable decrease in fear of movement, suggesting that a more comprehensive strengthening strategy may help patients return to daily activities with greater comfort and confidence.
For collaboration and inquiries, please contact Res. Asst. Utku Kurtaran at [email protected] and Assoc. Prof. Dr.Tuba Yerlikaya at [email protected].
About the researchers
Prof. Ahmet Özgül, MD specialist in physiatry and algology, focuses on interventional medicine in musculoskeletal disorders and rheumatic diseases along with orthopedic as well neurorehabilitation. His research interests include musculo-skeletal diagnostic and interventional ultrasonography, rheumatic/orthopedic rehabilitation strategies, interventional spinal pain procedures. Dr. Özgül contributes to evidence-based rehabilitation practices that combine advanced diagnostic methods with comprehensive patient care. He can be reached at [email protected], [email protected].
Assoc. Prof. Dr. Tuba Yerlikaya is a faculty member at the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Near East University (NEU), Northern Cyprus. Her research focuses on musculoskeletal rehabilitation, neuromuscular assessment, kinesiophobia, postural control, and functional outcomes across different age groups, with particular emphasis on low back pain, shoulder disorders, geriatric rehabilitation, and telerehabilitation. She has published extensively in respected international journals on topics such as muscle degeneration and asymmetry, fat infiltration and cross-sectional muscle analysis, balance and fall risk in older adults, psychosocial factors in musculoskeletal disorders, and rehabilitation strategies for chronic conditions. Through her work, Assoc. Prof. Dr. Yerlikaya contributes to evidence-based physiotherapy practices that integrate clinical evaluation with functional and psychosocial perspectives. For collaboration and inquiries, she can be reached at [email protected].
Utku Kurtaran is a PhD student in the Department of Physiotherapy and Rehabilitation at Near East University and a practicing physiotherapist at Near East University Hospital. His academic and clinical work focuses on neurorehabilitation and musculoskeletal rehabilitation, with an emphasis on shoulder disorders and stroke-related functional limitations. His work is grounded in the International Classification of Functioning, Disability and Health (ICF) framework, with a particular focus on examining the relationship between ICF-based biopsychosocial factors and community participation in individuals living with stroke in North Cyprus. In the field of shoulder rehabilitation, his primary focus is subacromial pain syndrome, particularly shoulder biomechanics and targeted exercise interventions, including humeral head depressor muscle–focused exercises and their effects on acromiohumeral distance, tendon morphology, pain, and upper-extremity function. For collaboration and inquiries, he can be reached at [email protected].
Abstract
Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio–humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution.
