Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial

Abstract

The aim of this prospective, randomized clinical study was to compare the effectiveness of two physical therapy treatment approaches for impingement syndrome, either by joint and soft tissue mobilization techniques or by a self-training program. Thirty patients (Group 1, n = 15; Group 2, n = 15) with the diagnosis of an outlet impingement syndrome of the shoulder were treated either by strengthening the depressors of the humeral head with a guided self-training program (Group 1, age 49.5 +/- 7.9 years), or by joint and soft tissue mobilization techniques (Group 2, age 48.1 +/- 7.5 years). Group 1 was instructed with the active range of motion (ROM), stretching and strengthening exercise program including rotator cuff muscles, rhomboids, levator scapulae and serratus anterior with an elastic band at home at least seven times a week for 10-15 min and Group 2 received a prescription for 12 sessions of joint and soft tissue mobilization techniques, ice application, stretching and strengthening exercise programs and patient education in clinic for three times per week. All patients were tested with visual analog scale (VAS) for pain level, goniometric measurement for ROM and algometry for the pain threshold. Function was measured with a functional assessment questionnaire. The VAS (10 cm) used to measure pain with functional activities and the functional assessment questionnaire (Neer) were also measured 3 months after the initiation of treatment. Subjects in both groups experienced significant decreases in pain and increases in shoulder function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pre-treatment mean (+/-SD) of 6.7 (+/-0.3) to a post-treatment mean of 2.0 (+/-2.0). In contrast, pain in the exercise group was reduced from a pre-treatment mean of 6.6 (+/-1.4) to a post-treatment mean of 3.0 (+/-1.8). ROM at flexion, abduction and external rotation in the manual therapy group improved significantly while ROM in the exercise group did not. There were statistically differences among the groups in function (P > 0.05). Group 2 showed significantly greater improvements in the Neer Questionnaire score and shoulder satisfaction score than Group 1. The patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength, decreasing pain and improving function earlier than with exercise program.

The Effect of Therapeutic Exercise and Mobilization on Patients With Shoulder Dysfunction: A Systematic Review With Meta-analysis

“…S even studies 2,5,8,20,34,39,47 met the inclusion criteria and were relative to the research question, thus were included in this analysis. One subgroup of a study 47 was not included because the participant characteristics met the exclusion criteria defined for this literature review.…”

“…In addition, 2 subgroups of another study 20 were excluded because the treatment parameters met the exclusion criteria. One study 39 did not accurately document results of ROM, function, and disability, so these measures were not included in the analysis.…”

“…Six studies 2,5,8,20,34,39 compared the effect of therapeutic exercise to the combination of therapeutic exercise and mobilization. One study 47 compared the effect of therapeutic exercise with mobilization alone.…”

“…One study 47 compared the effect of therapeutic exercise with mobilization alone. Comparison of the effects of therapeutic exercise and the combination of therapeutic exercise and mobilization was performed on pain in 6 studies, 2,8,20,34,39,47 on ROM in 4 studies, 5,8,20,34 and on function or disability in 3 studies. 2,5,20 The 7 included studies provided data on a total of 290 participants, out of which 146 were allocated to the experimental group and 144 to the comparison group.…”

“…The Cochran Q test of heterogeneity was calculated along with sensitivity analysis to identify any study that could have skewed the data, making the results more heterogeneous. In 1 study, 39 a categorical variable was used to assess the improvement in function and disability. Due to the very small sample size, a Fisher exact test was performed and a 1-tailed P value was generated by computer analysis for this variable.…”