OBJECTIVE: To investigate the effect of individualized manual physiotherapy and exercises compared with individualized exercises alone in patients with shoulder impingement syndrome.
DESIGN: Randomized controlled trial.
SUBJECTS: Patients with shoulder impingement of more than 4 weeks' duration.
METHODS: Patients in the intervention group were treated with individually adapted exercises and examination-based physiotherapy. Controls were treated with individually adapted exercises only. Both groups had 10 treatment sessions over a period of 5 weeks and subsequently continued their exercises at home for another 7 weeks. Results were analysed at 5 and 12 weeks after the start of the study. Primary outcome measures were: Shoulder Pain and Disability Index, and Patient's Global Impression of Change. Secondary outcome measures were: mean weekly pain score; Generic Patient-Specific Scale; and Patients' Satisfaction with Treatment.
RESULTS: A total of 46 patients were randomized to the intervention group and 44 to the control group. Although both groups showed significant improvements, there was no difference between groups for the primary and secondary outcomes at any time. Only the results for mean pain differed at 5 weeks in favour of the intervention group.
CONCLUSION: Individually adapted exercises were effective in the treatment of patients with shoulder impingement syndrome. Individualized manual physiotherapy contributed only a minor amount to the improvement in pain intensity. However, further research is necessary to confirm these results before definite recommendations can be made.
Summary: The aim of the study was to identify the differences in functionality of the upper limb in subjects suffering from shoulder impingement syndrome after intervention by two manual therapy protocols. Randomized, single-blind study with a sample of 22 subjects (58 ± 10.86 years old) divided into two groups. The conventional-group (n = 11) received mobilizations of the shoulder and the experimental-group (n = 11) was treated with soft tissue techniques in the cervical and upper thoracic regions. These two groups received electrotherapy and postural advices. The treatment lasted three weeks (15 daily sessions of 1 h and 30 min). Both active and passive range of motion (ROM) and self-perceived functionality of the upper limb (DASH questionnaire) were measured. The experimental group showed a significant improvement in the DASH scores and both groups improved mobility in the intra-group comparison pre-intervention versus post-intervention (p < .05), but not statistically significant differences were found in the between-group comparison (p > .05). Our results suggest that a combined treatment with electrotherapy, postural hygiene and manual therapy, regardless of the protocol, improves shoulder mobility and functionality.
OBJECTIVE: The purpose of this study was to compare the efficacy of Mobilization with Movement (MWM) and kinesiotaping (KT) techniques with a supervised exercise program in participants with patients with shoulder pain.
METHODS: Twenty subjects with shoulder pain were included if subjects were diagnosed by the referring physician with either rotator cuff lesion with impingement syndrome or impingement shoulder syndrome. Participants were randomly assigned to 1 of 2 groups after clinical and radiologic assessment: group 1 was treated with MWM and KT techniques, whereas group 2 was treated with a supervised exercise program. The main outcome measures were active pain-free shoulder abduction and flexion tested on days 0, 5, and 10.
RESULTS: Improvement in active pain-free shoulder range of motion was significantly higher in the group treated with MWM and KT. Repeated-measures analysis of variance indicated significant effects of treatment, time, and treatment×time interaction.
CONCLUSION: This study suggests that MWM and KT may be an effective and useful treatment in range of motion augmentation of subjects with rotator cuff lesion and impingement syndrome or impingement shoulder syndrome.
OBJECTIVES: The aim of this randomized controlled study was to assess the efficacy of manual therapy in the treatment of patients with symptomatic supraspinatus tendinopathy.
METHODS: Seventy-seven patients (age range, 30 to 55 years) with supraspinatus tendinopathy, were randomly assigned to one of the three treatment groups: a supervised exercise program (Group 1), a supervised exercise program combined with joint and soft tissue mobilization (Group 2), or a home-based rehabilitation program (Group 3). All patients had rehabilitation for 12 weeks. Pain level was evaluated with a visual analogue scale (VAS) and the range of motion (ROM) was measured with a goniometer. The Modified American Shoulder and Elbow Surgery (MASES) score was used in functional assessment. Flexion, abduction, internal and external rotation strengths were measured with a manual muscle test. All patients were evaluated before, and at the 4th and 12th week of the rehabilitation.
RESULTS: All groups experienced significant decrease in pain and an increase in shoulder muscle strength and function by both the 4th and 12th weeks of treatment (p<0.05). There was no significant difference between the groups in terms of function (p>0.05). However, the greatest improvement in functionality was found in Group 2.
CONCLUSION: Supervised exercise, supervised and manual therapy, and home-based exercise are all effective and promising methods in the rehabilitation of the patients with subacromial impingement syndrome. The addition of an initial manual therapy may improve the results of the rehabilitation with exercise.
BACKGROUND: Various manual therapy procedures are increasingly more often being used in the treatment of shoulder complex dysfunctions. The objective of the present study was to investigate whether manual therapy can improve the range of motion in the glenohumeral joint and alleviate pain in patients with chronic rotator cuff injuries
MATERIAL AND METHODS: The participants were randomly assigned to an experimental group and a control group of 15 patients each. Both groups received a standard combination therapy involving TENS, ultrasound therapy and kinesiotherapy. Additionally, the experimental group took part in a treatment programme designed by the authors composed of selected elements of various manual therapy techniques. Outcome evaluation focused on changes in the range of motion in the glenohumeral joint and changes in pain intensity (VAS scale) during the performance of functional tests. The results were subjected to statistical analysis.
RESULTS: More rapid and more significant pain reduction and more significant improvement in the range of motion of the glenohumeral joint across all movements tested were obtained in the experimental group.
CONCLUSION: The inclusion of manual therapy in standard comprehensive physiotherapy applied in the rehabilitation of patients with chronic rotator cuff injuries of the glenohumeral joint significantly improves treatment effectiveness.
Objective: To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease. Design: Randomised, participant and single assessor blinded, placebo controlled trial. Setting: Metropolitan region of Melbourne, Victoria, Australia. Participants: 120 participants with chronic (>3 months) rotator cuff disease recruited through medical practitioners and from the community. Interventions: The active treatment comprised a manual therapy and home exercise programme; the placebo treatment comprised inactive ultrasound therapy and application of an inert gel. Participants in both groups received 10 sessions of individual standardised treatment over 10 weeks. For the following 12 weeks, the active group continued the home exercise programme and the placebo group received no treatment. Main outcome measures: The primary outcomes were pain and function measured by the shoulder pain and disability index, average pain on movement measured on an 11 point numerical rating scale, and participants' perceived global rating of overall change. Results: 112 (93%) participants completed the 22 week trial. At 11 weeks no difference was found between groups for change in shoulder pain and disability index (3.6, 95% confidence interval -2.1 to 9.4) or change in pain (0.7, -0.1 to 1.5); both groups showed significant improvements. More participants in the active group reported a successful outcome (defined as "much better"), although the difference was not statistically significant: 42% (24/57) of active participants and 30% (18/61) of placebo participants (relative risk 1.43, 0.87 to 2.34). The active group showed a significantly greater improvement in shoulder pain and disability index than did the placebo group at 22 weeks (between group difference 7.1, 0.3 to 13.9), although no significant difference existed between groups for change in pain (0.9, -0.03 to 1.7) or for the percentage of participants reporting a successful treatment outcome (relative risk 1.39, 0.94 to 2.03). Several secondary outcomes favoured the active group, including shoulder pain and disability index function score, muscle strength, interference with activity, and quality of life. Conclusion: A standardised programme of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists' contact in middle aged to older adults with chronic rotator cuff disease. However, greater improvements were apparent at follow-up, particularly in shoulder function and strength, suggesting that benefits with active treatment take longer to manifest. Trial registration: Clinical trials NCT00415441.
OBJECTIVE: The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function. DESIGN: Pretest--posttest for 3 groups (SM, sham, and control). SETTING: A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic. PARTICIPANTS: 39 subjects (22 women, 17 men; mean age 54.30 ± 14.16 y, age range 20--77 y). INTERVENTIONS: A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program. MAIN OUTCOME MEASURES: Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function. RESULTS: After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05). CONCLUSIONS: SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.
To investigate the effect of individualized manual physiotherapy and exercises compared with individualized exercises alone in patients with shoulder impingement syndrome.
DESIGN:
Randomized controlled trial.
SUBJECTS:
Patients with shoulder impingement of more than 4 weeks' duration.
METHODS:
Patients in the intervention group were treated with individually adapted exercises and examination-based physiotherapy. Controls were treated with individually adapted exercises only. Both groups had 10 treatment sessions over a period of 5 weeks and subsequently continued their exercises at home for another 7 weeks. Results were analysed at 5 and 12 weeks after the start of the study. Primary outcome measures were: Shoulder Pain and Disability Index, and Patient's Global Impression of Change. Secondary outcome measures were: mean weekly pain score; Generic Patient-Specific Scale; and Patients' Satisfaction with Treatment.
RESULTS:
A total of 46 patients were randomized to the intervention group and 44 to the control group. Although both groups showed significant improvements, there was no difference between groups for the primary and secondary outcomes at any time. Only the results for mean pain differed at 5 weeks in favour of the intervention group.
CONCLUSION:
Individually adapted exercises were effective in the treatment of patients with shoulder impingement syndrome. Individualized manual physiotherapy contributed only a minor amount to the improvement in pain intensity. However, further research is necessary to confirm these results before definite recommendations can be made.
