Comparison of the effects of manual therapy and scapular stabilization exercises on pain, functional status, and quality of life in subacromial impingement syndrome

Aims: This study aimed to determine the effects of manual therapy and scapular stabilization exercises combined with conventional physiotherapy on pain, functional status, and quality of life, and whether they are superior in individuals with subacromial impingement. Methods: 30 patients between the ages of 25-65 who were diagnosed with subacromial impingement syndrome were included in the study. Individuals were randomized 1:1 to "conventional physiotherapy+scapular stabilization" and "conventional physiotherapy+manual therapy" groups. Individuals' age, gender, medication use, and presence of chronic disease were recorded. The presence of pain was measured by the Visual Analogue Scale, shoulder range of motion was measured by a goniometer, quality of life was measured by Short Form-12 Quality of Life Survey, and functional status was evaluated with the Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems. The conventional physiotherapy program applied to both groups included electrotherapy, passive and active assisted range of motion exercises, and rotator cuff strengthening exercises. Both groups received a total of 12 sessions of physiotherapy, 3 days per week, for 4 weeks. Results: 19 females and 11 males, participated in the study. There were no statistically significant differences between the groups at baseline assessment for pain at rest, activity, and night (p=0,37; 0,39; 0,17, respectively), range of motion of shoulder flexion, abduction, internal rotation, and, external rotation (p=0,5; 0,1; 0,91; 0,9, respectively), Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems score (p: 0,09) and Short Form-12 Quality of Life Survey scores physical and mental component (p=0,23; 0,98, respectively). After treatment, both groups observed positive improvements in pain at rest, activity, and night (p=0,001), range of motion of shoulder flexion, abduction, internal rotation, and, external rotation (p=0,001), Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems score (p=0,001) and Short Form-12 Quality of Life Survey scores physical and mental component (Group1; p=0,001; 0,001, Group 2; p=0,001; 0,005, respectively). There was no statistically significant advantage among the treatment methods except for shoulder abduction and internal rotation range of motion parameters (p=0,04; 0,009, respectively). Conclusion: When applied with traditional physiotherapy, both treatment methods provided significant improvements in pain, functional condition, quality of life, and joint motion clarity compared to before treatment. However, the methods applied are not superior to each other. It is important to choose the appropriate technique for the patient in the treatment of subacromial impingement syndrome, and it is useful to prepare personalized, combined programs. It is envisaged that researching more effective exercise methods for patients with subacromial impingement syndrome in the future will increase the usefulness of the treatment.

Keywords:

Manual therapy, Scapular stabilization Rehabilitation, Subacromial impingement syndrome,

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Halder AM, Itoi E, An KN. Anatomy and biomechanics of the shoulder. Orthop Clin North Am. 2000;31(2):159-76. doi:10.1016/s0030-5898(05)70138-3
Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-776. doi:10.3238/arztebl.2017.0765
Hanratty CE, McVeigh JG, Kerr DP, et al. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum. 2012;42(3):297-316. doi:10.1016/j.semarthrit.2012.03.015
Neer CS, 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;(173):70-7.
Tyler TF, Nahow RC, Nicholas SJ, McHugh MP. Quantifying shoulder rotation weakness in patients with shoulder impingement. J Shoulder Elbow Surg. 2005;14(6):570-4. doi:10.1016/j.jse.2005.03.003
Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology. Arch Phys Med Rehabil. 2011;92(7):1146-51. doi:10.1016/j.apmr.2011.02.004
Sahin E, Dilek B, Baydar M, et al. Shoulder proprioception in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2017;30(4):857-862. doi:10.3233/bmr-160550
Çelik MS, Sönmezer E, Acar M. Effectiveness of proprioceptive neuromuscular facilitation and myofascial release techniques in patients with subacromial impingement syndrome. Somatosens Mot Res. 2022;39(2-4):97-105. doi:10.1080/08990220.2021.2018293
Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314-22. doi:10.3109/17453674.2014.920991
Bilek F, Karakaya MG, Karakaya İ. Immediate effects of TENS and HVPS on pain and range of motion in subacromial pain syndrome: A randomized, placebo-controlled, crossover trial. J Back Musculoskelet Rehabil. 2021;34(5):805-811. doi:10.3233/bmr-191833
Yildirim MA, Ones K, Celik EC. Comparison of ultrasound therapy of various durations in the treatment of subacromial impingement syndrome. J Phys Ther Sci. 2013;25(9):1151-4. doi:10.1589/jpts.25.1151
Dong W, Goost H, Lin XB, et al. Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis. Medicine (Baltimore). 2015;94(10):e510. doi:10.1097/md.0000000000000510
Shire AR, Stæhr TAB, Overby JB, Bastholm Dahl M, Sandell Jacobsen J, Høyrup Christiansen D. Specific or general exercise strategy for subacromial impingement syndrome- does it matter? a systematic literature review and meta-analysis. BMC Musculoskelet Disord. 2017;18(1):158. doi:10.1186/s12891-017-1518-0
Braun C, Bularczyk M, Heintsch J, Hanchard N. Manual therapy and exercises for shoulder impingement revisited. Physical Therapy Reviews. 2013;18:263-284. doi:10.1179/108331913X13709388114510
Shakeri H, Keshavarz R, Arab AM, Ebrahimi I. Clinical effectiveness of kinesiological taping on pain and pain-free shoulder range of motion in patients with shoulder impingement syndrome: a randomized, double-blinded, placebo-controlled trial. Int J Sports Phys Ther. 2013;8(6):800-10.
Pieters L, Lewis J, Kuppens K, et al. An Update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. J Orthop Sports Phys Ther. 2020;50(3):131-141. doi:10.2519/jospt.2020.8498
Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther. 2004;17(2):152-64. doi:10.1197/j.jht.2004.02.004
World Medical A. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization. 2001;79(4):373-374.
Hopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomized controlled trial. Lancet. 2021;398(10298):416-428. doi:10.1016/s0140-6736(21)00846-1
Crichton N. Visual analogue scale (VAS). J Clin Nurs. 2001;10(5): 697-706.
Otman AS, Demirel H, Sade A. Tedavi hareketlerinde temel değerlendirme prensipleri. Pelikan yayıncılık; 2014.
Ware J, Jr., Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-33. doi:10.1097/00005650-199603000-00003
Soylu C, Kütük B. Reliability and Validity of the Turkish Version of SF-12 Health Survey. Turk Psikiyatri Derg. 2022;33(2):108-117. SF-12 Yaşam Kalitesi Ölçeği’nin Türkçe Formunun Güvenirlik ve Geçerlik Çalışması. doi:10.5080/u25700
Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038-46. doi:10.2106/jbjs.D.02060
Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of the Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30(2):185-91. doi:10.1007/s10067-010-1470-y
Tanrkut A, özaras N, Kaptan H, Güven Z, Kayhan ö. High Voltage Galvanic Stimulation in Myofascial Pain Syndrome. J Musculoskelet Pain. 2010;11:11-15. doi:10.1300/J094v11n02_03
Gunay Ucurum S, Kaya DO, Kayali Y, Askin A, Tekindal MA. Comparison of different electrotherapy methods and exercise therapy in shoulder impingement syndrome: a prospective randomized controlled trial. Acta Orthop Traumatol Turc. 2018;52(4):249-255. doi:10.1016/j.aott.2018.03.005
Camargo PR, Alburquerque-Sendín F, Avila MA, Haik MN, Vieira A, Salvini TF. Effects of stretching and strengthening exercises, with and without manual therapy, on scapular kinematics, function, and pain in individuals with shoulder impingement: a randomized controlled trial. J Orthop Sports Phys Ther. 2015;45(12):984-97. doi:10.2519/jospt.2015.5939
Hotta GH, Gomes de Assis Couto A, Cools AM, McQuade KJ, Siriani de Oliveira A. Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: a randomized controlled trial. Musculoskelet Sci Pract. 2020;49:102171. doi:https://doi.org/10.1016/j.msksp.2020.102171
Sharma S, Ghrouz AK, Hussain ME, Sharma S, Aldabbas M, Ansari S. Progressive Resistance Exercises plus Manual Therapy Is Effective in Improving Isometric Strength in Overhead Athletes with Shoulder Impingement Syndrome: A Randomized Controlled Trial. Biomed Res Int. 2021;2021:9945775. doi:10.1155/ 2021/9945775
Berckmans K, Castelein B, Borms D, Palmans T, Parlevliet T, Cools A. Analysis of scapular kinematics and muscle activity by use of fine-wire electrodes during shoulder exercises. Am J Sports Med. 2020;48(5):1213-1219. doi:10.1177/0363546520908604
Kibler WB, McMullen J, Uhl T. Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am. 2001;32(3):527-38. doi:10.1016/s0030-5898(05)70222-4
Ronai P. Exercise Modifications and strategies to enhance shoulder function. Strength Condition J. 2005;27doi:10.1519/1533-4295 (2005)27[36:EMASTE]2.0.CO;2
Hertling D, Kessler RM. Management of common musculoskeletal disorders: physical therapy principles and methods. Lippincott Williams & Wilkins; 2006.
Negi M, Gupta M. An immediate effect of myofascial release therapy and combined approach on myofascial trigger points in upper fibers of trapezius: a comparative study. Indian J Health Sci Care. 2021;8(spl):10-10.
Yang JL, Jan MH, Chang CW, Lin JJ. Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial. Man Ther. 2012;17(1):47-52. doi:10.1016/j.math.2011.08.006
Liaghat B, Pedersen JR, Husted RS, Pedersen LL, Thorborg K, Juhl CB. Diagnosis, prevention, and treatment of common shoulder injuries in sport: grading the evidence - a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med. 2023;57(7):408-416. doi:10.1136/bjsports -2022-105674
Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi:10.1080/03009740310004667
Ginn KA, Cohen ML. Conservative treatment for shoulder pain: prognostic indicators of outcome. Arch Phys Med Rehabil. 2004;85(8):1231-1235. doi:10.1016/j.apmr.2003.09.013
Bergman GJ, Winters JC, van der Heijden GJ, Postema K, Meyboom-de Jong B. Groningen Manipulation Study. The effect of manipulation of the structures of the shoulder girdle as an additional treatment for symptom relief and for prevention of chronicity or recurrence of shoulder symptoms. Design of a randomized controlled trial within a comprehensive prognostic cohort study. J Manipulative Physiol Ther. 2002;25(9):543-9. doi: 10.1067/mmt.2002.128373
Lombardi I, Jr., Magri AG, Fleury AM, Da Silva AC, Natour J. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum. 2008;59(5):615-22. doi:10.1002/art.23576
Surenkok O, Aytar A, Baltaci G. Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial. J Sport Rehabil. 2009;18(4):493-501. doi:10.1123/jsr.18.4.493
Turgut E, Duzgun I, Baltaci G. Effects of scapular stabilization exercise training on scapular kinematics, disability, and pain in subacromial impingement: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(10):1915-1923.e3. doi:10.1016/j.apmr.2017.05.023
Steuri R, Sattelmayer M, Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017;51(18):1340-1347. doi:10.1136/bjsports-2016-096515