Effect of Closed Kinetic Chain Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Disability and Function of Post Operative Rotator Cuff Injury

Effect of Closed Kinetic Chain Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Disability and Function of Post Operative Rotator Cuff Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Closed Kinetic Chain Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Disability and Function of Post Operative Rotator Cuff Injury Raunak Jaiswal, Pallavi Harjpal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8777584/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 18 You are reading this latest preprint version Abstract Background The shoulder complex demonstrates little to no structural integrity and therefore is prone to multiple injuries, especially in regard to the rotator cuff (RC). RC injury is caused primarily by degenerative changes, micro-trauma secondary to repetitive use, altered mechanics of the scapula, and loss of neuromuscular function. Closed kinetic chain (CKC) exercises and Proprioceptive Neuromuscular Facilitation (PNF) techniques are common interventions in rehabilitation; however, comparative evidence supporting their use following RC repair has been limited. Methods An entire of 120 patients who go through postoperative RC repair were selected and randomly divided into Group A (Closed Kinetic Chain (CKC) exercises) and Group B (PNF techniques) for this randomised controlled trial. Each group contained 60 participants, and the treatment consisted of half hour sessions, 5 days a week, for four weeks. The Shoulder Pain and Disability Indicator (SPADI) and the Western Ontario Rotator Cuff Indicator (WORC) were used to evaluate the results before the start of the study and after completing the four-week training programme. Results There was statistically significant improvement in both SPADI and WORC (p = 0.0001), which indicates a reduction of pain and disability and an increase in functional recovery, after both groups received treatment. The results of the intergroup analysis showed that the mean SPADI scores were not statistically significant (p = 0.87), which suggests that both techniques were equally effectual in terms of pain and disability reduction. On the contrary, the mean WORC scores between both groups were statistically significant (p = 0.0001). Conclusion This study demonstrated that CKC and PNF techniques are equally important in the rehabilitation process of post-operative RCrepair. Although pain and disability outcomes were comparable with each other, the PNF techniques yielded higher functional recovery. The results reinforce the importance of neuro-muscular facilitation and functional integration as a means to improving both post-operative shoulder function and quality of life. Rotator cuff injury Closed kinetic chain exercises Proprioceptive neuromuscular facilitation Shoulder pain SPADI WORC Post-operative rehabilitation Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviews received at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers invited by journal 10 Feb, 2026 Editor invited by journal 05 Feb, 2026 Editor assigned by journal 05 Feb, 2026 Submission checks completed at journal 05 Feb, 2026 First submitted to journal 03 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8777584","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590513186,"identity":"4461f408-6209-4276-b216-0e2bbaea1252","order_by":0,"name":"Raunak Jaiswal","email":"","orcid":"","institution":"UG Scholar, Ravi Nair Physiotherapy College Sawangi (Meghe)","correspondingAuthor":false,"prefix":"","firstName":"Raunak","middleName":"","lastName":"Jaiswal","suffix":""},{"id":590513187,"identity":"9157454b-0458-45f7-a423-80563c3e4a06","order_by":1,"name":"Pallavi Harjpal","email":"data:image/png;base64,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","orcid":"","institution":"Ravi Nair Physiotherapy college, Sawangi (Meghe)","correspondingAuthor":true,"prefix":"","firstName":"Pallavi","middleName":"","lastName":"Harjpal","suffix":""}],"badges":[],"createdAt":"2026-02-03 15:10:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8777584/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8777584/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102748292,"identity":"4c468d37-b519-4d1c-8946-cc6caa831691","added_by":"auto","created_at":"2026-02-16 09:06:47","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":483812,"visible":true,"origin":"","legend":"","description":"","filename":"RaunakMusculoManuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8777584/v1_covered_dde63f00-1c30-407f-9549-34dcaf6f3fd0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of Closed Kinetic Chain Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Disability and Function of Post Operative Rotator Cuff Injury\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rotator cuff injury, Closed kinetic chain exercises, Proprioceptive neuromuscular facilitation, Shoulder pain, SPADI, WORC, Post-operative rehabilitation","lastPublishedDoi":"10.21203/rs.3.rs-8777584/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8777584/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe shoulder complex demonstrates little to no structural integrity and therefore is prone to multiple injuries, especially in regard to the rotator cuff (RC). RC injury is caused primarily by degenerative changes, micro-trauma secondary to repetitive use, altered mechanics of the scapula, and loss of neuromuscular function. Closed kinetic chain (CKC) exercises and Proprioceptive Neuromuscular Facilitation (PNF) techniques are common interventions in rehabilitation; however, comparative evidence supporting their use following RC repair has been limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn entire of 120 patients who go through postoperative RC repair were selected and randomly divided into Group A (Closed Kinetic Chain (CKC) exercises) and Group B (PNF techniques) for this randomised controlled trial. Each group contained 60 participants, and the treatment consisted of half hour sessions, 5 days a week, for four weeks. The Shoulder Pain and Disability Indicator (SPADI) and the Western Ontario Rotator Cuff Indicator (WORC) were used to evaluate the results before the start of the study and after completing the four-week training programme.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was statistically significant improvement in both SPADI and WORC (p\u0026thinsp;=\u0026thinsp;0.0001), which indicates a reduction of pain and disability and an increase in functional recovery, after both groups received treatment. The results of the intergroup analysis showed that the mean SPADI scores were not statistically significant (p\u0026thinsp;=\u0026thinsp;0.87), which suggests that both techniques were equally effectual in terms of pain and disability reduction. On the contrary, the mean WORC scores between both groups were statistically significant (p\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study demonstrated that CKC and PNF techniques are equally important in the rehabilitation process of post-operative RCrepair. Although pain and disability outcomes were comparable with each other, the PNF techniques yielded higher functional recovery. The results reinforce the importance of neuro-muscular facilitation and functional integration as a means to improving both post-operative shoulder function and quality of life.\u003c/p\u003e","manuscriptTitle":"Effect of Closed Kinetic Chain Exercises Versus Proprioceptive Neuromuscular Facilitation Technique on Pain, Disability and Function of Post Operative Rotator Cuff Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 20:22:14","doi":"10.21203/rs.3.rs-8777584/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T08:27:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T12:56:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T09:31:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303993101711140867834596752391357790924","date":"2026-02-12T21:31:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154595987077794813982854951665028812897","date":"2026-02-11T17:48:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311918498620139119846509977975678129882","date":"2026-02-11T10:04:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-11T06:36:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54141633544763816262564047311824700465","date":"2026-02-11T06:24:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73029826672409805955253729523733198662","date":"2026-02-10T10:42:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T09:39:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26840595012174393965042190982875883992","date":"2026-02-10T09:36:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79916087208819546458893369663648572346","date":"2026-02-10T08:58:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132936717773011388434078845176894069846","date":"2026-02-10T06:38:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-10T06:31:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-05T17:30:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-05T10:56:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-05T10:49:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-02-03T14:45:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf5703d1-e771-4a6c-b883-723931c8c5d8","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T08:39:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 20:22:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8777584","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8777584","identity":"rs-8777584","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}