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Liu S, Chen L, Shi Q, Fang Y, Da W, Xue C, Li X. Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis. Biomed Rep 2024; 20:89. [PMID: 38682089 PMCID: PMC11046180 DOI: 10.3892/br.2024.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
To critically evaluate the effects of manual therapy (MT) on pain and functional improvement in patients with rotator cuff injury (RCI), a systematic review of all randomized controlled trials (RCTs) on MT for RCI was conducted in the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Physiotherapy Evidence Database, Chinese National Knowledge Infrastructure, Wan-fang Data, Chinese Scientific Journal Database, and Chinese Biomedical Literature database from inception to March 28, 2023. A total of 1,110 participants from 24 eligible RCTs were included in the analysis. Compared with placebo, MT could not effectively relieve pain [standardized mean difference (SMD)=-0.25; 95% CI: -0.51 to 0.01; P=0.06], although its impact on functional improvement appears limited (SMD=0.20; 95% CI: -0.09 to 0.49; P=0.18). Combining MT with exercise had significant advantages over exercise alone, as combined therapy contributed to both pain reduction (SMD=0.36; 95% CI: 0.08 to 0.64; P=0.01) and functional enhancement (SMD=0.32; 95% CI: 0.11 to 0.52; P=0.002). Furthermore, MT combined with multimodal physiotherapy showed additional benefits in pain reduction (mean difference=1.57; 95% CI: 0.18 to 2.96; P=0.03) and functional improvement (SMD=0.77; 95% CI: 0.43 to 1.12; P<0.0001) compared with multimodal physiotherapy alone. These findings highlight the superior pain alleviation and functional improvement provided by MT when combined with exercise or physiotherapy. Consequently, MT has emerged as a pivotal component of therapeutic intervention for RCI.
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Affiliation(s)
- Shuang Liu
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Lin Chen
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Qi Shi
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Yide Fang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Weiwei Da
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Chunchun Xue
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Xiaofeng Li
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
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Flowers DW, Swanson BT, Shaffer SM, Clewley DJ, Riley SP. Is there 'trustworthy' evidence for using manual therapy to treat patients with shoulder dysfunction?: A systematic review. PLoS One 2024; 19:e0297234. [PMID: 38236928 PMCID: PMC10796022 DOI: 10.1371/journal.pone.0297234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/01/2024] [Indexed: 01/22/2024] Open
Abstract
The primary objective of this review was to create a 'trustworthy,' living systematic review and meta-analysis for the application of manual therapy interventions in treating patients with shoulder dysfunction. Included studies were English-language randomized controlled trials published between 1/1/2010 and 8/3/2023, with searches performed in: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINHAL, ProQuest Nursing & Allied Health, EBSCO Medline, and PEDro. The population of focus included adults 18 years and older with musculoskeletal impairments related to shoulder dysfunction. Our primary outcomes included pain and region-specific outcome measures. We excluded trials, including participants having shoulder dysfunction resulting from surgery, radicular pain, instability/dislocation, fracture, lymphedema, and radiation. Our screening methodology was based upon a previously published 'trustworthy' systematic review protocol. This included the application of our PICOTS criteria in addition to screening for prospective clinical trial registration and following of prospective intent, as well as assessment of PEDro scores, risk-of-bias ratings, GRADE scoring, and examination of confidence in estimated effects. Twenty-six randomized controlled trials met our PICOTS criteria; however, only 15 of these were registered. Only three were registered prospectively. Two of these did not have discussions and conclusions that aligned with their primary outcome. The remaining single study was found to have a high risk-of-bias, meaning the remainder of the protocol could not be employed and that no randomized controlled trials could undergo further assessment or meta-analysis. The results of this systematic review indicate there are no 'trustworthy' randomized controlled trials examining the effectiveness of manual therapy interventions for the treatment of patients with shoulder dysfunction, as defined by the prospectively established methodology. Therefore, these findings signal that creating a 'trustworthy,' living systematic review on this clinically relevant topic is not yet possible due to a lack of 'trustworthy' randomized controlled trials.
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Affiliation(s)
- Daniel W. Flowers
- Doctor of Physical Therapy Program, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, United States of America
| | - Brian T. Swanson
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, United States of America
| | - Stephen M. Shaffer
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, United States of America
| | - Derek J. Clewley
- Doctor of Physical Therapy Division, School of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Center for Excellence in Manual and Manipulative Therapy, Duke University, Durham, North Carolina, United States of America
| | - Sean P. Riley
- Hartford Healthcare Rehabilitation Network, Glastonbury, Connecticut, United States of America
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Dias D, Neto MG, Sales SDSR, Cavalcante BDS, Torrierri P, Roever L, de Araújo RPC. Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7416. [PMID: 38068468 PMCID: PMC10706990 DOI: 10.3390/jcm12237416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 08/08/2024] Open
Abstract
BACKGROUND Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. OBJECTIVE To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment. METHODS A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest. RESULTS Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (-0.6; 95% confidence interval, -1.1 to -0.1, I2 = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I2 = 73%; N = 90) compared to sham MWM in the short term (0-6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (-1.2; -2.2 to -0.2; I2 = 61%; N = 100), and disability SMD of (-1.3; confidence interval -2.2 to -0.4; I2 = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I2 = 89%; N = 130) in the short term. There is no information regarding long-term effects. CONCLUSION Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.
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Affiliation(s)
- Daniela Dias
- Physiotherapy Department, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia (UFBA), Salvador 40110-170, Brazil;
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil;
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Mansueto Gomes Neto
- Physiotherapy Department, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia (UFBA), Salvador 40110-170, Brazil;
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil;
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Stephane da Silva Ribeiro Sales
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Bárbara dos Santos Cavalcante
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Palmiro Torrierri
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Leonardo Roever
- Department of Clinical Research, Brazilian Evidence-Based Health Network, Uberlândia 38408-100, Brazil
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1401, Lebanon
| | - Roberto Paulo Correia de Araújo
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil;
- Biochemistry Department, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil
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Wang S, Zeng J, Chapple CM, Mani R, Ribeiro DC. Initial effect of high-volume mobilisation with movement on shoulder range of motion and pain in patients with rotator cuff-related shoulder pain: protocol for a randomised controlled trial (Evolution Trial). BMJ Open 2023; 13:e069919. [PMID: 37558449 PMCID: PMC10414061 DOI: 10.1136/bmjopen-2022-069919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Mobilisation with movement (MWM) is commonly used for treating patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving shoulder range of motion (ROM) and pain in patients with RCRSP is limited. It is also unclear whether higher volume MWM leads to better clinical outcomes compared with lower volume MWM in patients with RCRSP. The primary aim of this study is to assess the effect of MWM on the angular onset of pain during shoulder abduction in patients with RCRSP. METHODS AND ANALYSIS Sixty participants with RCRSP will be randomised to receive either MWM or sham MWM intervention. The primary outcome is the angular onset of pain during shoulder abduction, and secondary outcomes are pain intensity at the angular onset of pain during shoulder abduction, maximum shoulder ROM, pain intensity during maximum shoulder abduction, pressure pain threshold, mechanical temporal summation, global rating of change scale (GROC) and Brief Pain Inventory-Short Form (BPI-SF). The angular onset of pain and the pain intensity at that range will be assessed at baseline, after 1 set and 3 sets of 10 repetitions of MWM or sham MWM. The GROC will be measured immediately after receiving 3 sets of interventions and on day 3 after interventions. The BPI-SF will be measured on days 1, 3, 5 and 7 after interventions. Other secondary outcomes will be assessed at baseline and after 3 sets of interventions. A linear mixed effects model with a random intercept will be used to compare changes in the outcome measures between MWM and sham MWM interventions. ETHICS AND DISSEMINATION This study has been approved by the University of Otago Ethics Committee (Ref. H21/117). Findings from this study will be disseminated through presentations at international and national conferences and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN 12621001723875.
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Affiliation(s)
- Sizhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Cathy M Chapple
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Nørgaard Sørensen L, Delafin M, Baptista M, Medforth NR, Ruffini N, Skøtt Andresen S, Ytier S, Ali D, Hobday H, Santosa AANAA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article I): a systematic review and description of methods. Pain 2023; 164:469-484. [PMID: 36265391 PMCID: PMC9916059 DOI: 10.1097/j.pain.0000000000002723] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/17/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Section for Psychology and Neuroscience, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Department of Psychology, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
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Bourke J, Skouteris H, Hatzikiriakidis K, Fahey D, Malliaras P. Use of Behavior Change Techniques Alongside Exercise in the Management of Rotator Cuff-Related Shoulder Pain: A Scoping Review. Phys Ther 2022; 102:6482025. [PMID: 34972867 DOI: 10.1093/ptj/pzab290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The aims of this scoping review were to: (1) determine the frequency and types of behavior change techniques (BCTs) and education utilized in trials investigating exercise interventions for rotator cuff related shoulder pain (RCRSP); (2) subcategorize the BCTs and education found in the trials to summarize all behavior change approaches reported by trials; and (3) compare the frequency, types, and subcategories of BCTs and education utilized in the clinical guidelines for managing RCRSP between the trials. METHODS Data sources included Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, Google Scholar and PubMed, which were searched from inception to June 2020. Trials assessing exercise interventions for RCRSP were included. Three authors independently determined eligibility and extracted data. The frequency and types of BCTs and education in the trials and clinical practice guidelines were reported and compared descriptively. Two authors assessed the content of the BCTs to develop subcategories. RESULTS Most trials reported including at least 1 type of BCT (89.2%), which was most commonly feedback and monitoring (78.5%). There were many different approaches to the BCTs and education; for example, feedback and monitoring was subcategorized into supervised exercise, exercise monitoring, and feedback through external aids, such as mirrors. Clinical guidelines recommend supervision, goal setting, activity modification, pain management recommendations, information about the condition, and exercise education. CONCLUSION Although over two-thirds of trials reported including a BCT alongside exercise interventions for RCRSP, the breadth of these interventions is limited (supervision is the only common one). Future trialists should consider using any type of BCT that may improve exercise adherence and outcomes. IMPACT The findings of this review have: (1) identified gaps in the literature; and (2) contributed to the design of future exercise interventions for RCRSP.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kostas Hatzikiriakidis
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Fahey
- Enhance Sports Performance and Rehabilitation, Maribyrnong, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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Satpute K, Reid S, Mitchell T, Mackay G, Hall T. Efficacy of mobilization with movement (MWM) for shoulder conditions: a systematic review and meta-analysis. J Man Manip Ther 2021; 30:13-32. [PMID: 34334099 DOI: 10.1080/10669817.2021.1955181] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: To assess the effects of mobilization with movement (MWM) on pain, range of motion (ROM), and disability in the management of shoulder musculoskeletal disorders. Methods: Six databases and Scopus, were searched for randomized control trials. The ROB 2.0 tool was used to determine risk-of-bias and GRADE used for quality of evidence. Meta-analyses were performed for the sub-category of frozen shoulder and shoulder pain with movement dysfunction to evaluate the effect of MWM in isolation or in addition to exercise therapy and/or electrotherapy when compared with other conservative interventions.Results: Out of 25 studies, 21 were included in eight separate meta-analyses for pain, ROM, and disability in the two sub-categories. For frozen shoulder, the addition of MWM significantly improved pain (SMD -1.23, 95% CI -1.96, -0.51)), flexion ROM (MD -11.73, 95% CI -17.83, -5.64), abduction ROM (mean difference -13.14, 95% CI -19.42, -6.87), and disability (SMD -1.50, 95% CI (-2.30, -0.7). For shoulder pain with movement dysfunction, the addition of MWM significantly improved pain (SMD -1.07, 95% CI -1.87, -0.26), flexion ROM (mean difference -18.48, 95% CI- 32.43, -4.54), abduction ROM (MD -32.46, 95% CI - 69.76, 4.84), and disability (SMD -0.88, 95% CI -2.18, 0.43). The majority of studies were found to have a high risk of bias. Discussion: MWM is associated with improved pain, mobility, and function in patients with a range of shoulder musculoskeletal disorders and the effects clinically meaningful. However, these findings need to be interpreted with caution due to the high levels of heterogeneity and risk of bias. Level of Evidence: Treatment, level 1a.
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Affiliation(s)
- Kiran Satpute
- Department of Musculoskeletal Physiotherapy smt. Kashibai Navale College of Physiotherapy, Pune, India
| | - Sue Reid
- Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia
| | | | | | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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González ÁC, Berenguer SB, Luque Mañas JM, Martin-Pintado-Zugasti A. Validation of a sham novel neural mobilization technique in patients with non-specific low back pain: A randomized, placebo-controlled trial. Musculoskelet Sci Pract 2021; 53:102378. [PMID: 33930856 DOI: 10.1016/j.msksp.2021.102378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no validated sham neural mobilization (NM) intervention for lower quadrant conditions. A suitable sham NM comparator will allow to blind patients with low back pain (LBP) and reduce bias by limiting the confounding effects of expectations. OBJECTIVE The primary aim was to develop a sham NM technique in patients with non-specific LBP and assess its validity in supplying a suitable blinding. Secondly, we compared the short-term effects of NM and the sham comparator on pain and the straight leg raise. DESIGN A randomized placebo-controlled trial in which participants and assessors were blinded. METHOD Fifty one patients (20 men,31 women), aged 22-65 years (43 ± 12y) were allocated randomly to a NM group (n = 26) or a sham NM group (n = 25). The primary outcome of believability of the sham technique was measured one week after the intervention. Secondary outcomes of pain intensity and the straight leg raise range-of-motion were assessed at baseline, immediately after the intervention and one week after. RESULTS The believability of the sham technique in terms of the frequencies of perceived group assignment showed no differences between groups. Eighteen participants believed they had received the experimental NM technique in the experimental group (69.2%) and 14 in the placebo NM group (56%). Pain and the straight leg raise changes did not show differences between groups. CONCLUSIONS The novel sham NM demonstrated to be a believable intervention, capable of supplying a suitable blinding. Both groups showed similar short term perceived effects on pain and the straight leg raise.
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Affiliation(s)
| | | | | | - Aitor Martin-Pintado-Zugasti
- Department of Physiotherapy, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain.
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Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2021; 51:72-81. [PMID: 32857944 DOI: 10.2519/jospt.2021.9785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). DESIGN Randomized, single-blinded, multicenter parallel-group trial. METHODS Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. RESULTS At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). CONCLUSION Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. J Orthop Sports Phys Ther 2021;51(2):72-81. Epub 28 Aug 2020. doi:10.2519/jospt.2021.9785.
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Baeske R, Hall T, Silva MF. The inclusion of mobilisation with movement to a standard exercise programme for patients with rotator cuff related pain: a randomised, placebo-controlled protocol trial. BMC Musculoskelet Disord 2020; 21:744. [PMID: 33183274 PMCID: PMC7663889 DOI: 10.1186/s12891-020-03765-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Rotator cuff related pain (RCRP) is one of the most common sources of musculoskeletal shoulder pain affecting the general population. Conservative treatment, in the form of exercise, is considered the first line approach, nonetheless, improvements seem to be modest. One therapeutic modality that might be an adjunct to the treatment of this condition is mobilisation with movement (MWM). MWM is a pain-free manual procedure that targets restricted and painful movements, commonly seen in patients with RCRP. The purpose of clinical trial is to determine whether MWM with exercise has benefits over sham MWM with exercise in RCRP. Methods A randomised, sham-controlled trial of 70 adults complaining of RCRP will compare the effects of MWM combined with exercise over sham MWM with exercise. Participants will be allocated to one of two groups: exercise and MWM (EG) or exercise and sham MWM (CG). Two weekly individual treatment sessions will be conducted over five weeks. All assessments will be performed by a blinded assessor. Primary outcome measures will be the shoulder pain and disability index (SPADI) and the numeric pain rating scale (NPRS), assessed at baseline, discharge and one-month follow-up. Secondary outcome measures will be active range of motion, self-efficacy and the global rating of change scale. The analyses will be conducted considering a statistically significant p-value ≤0.05. Normality will be assessed with the Kolmogorov-Smirnov test and homogeneity with the Levene’s test. For the primary outcome measures (SPADI and NPRS) and self-efficacy, a 2 × 3 ANOVA with treatment group (EG versus CG) and time (baseline, end of the treatment and follow-up) factors will be performed. Separate 2 × 2 ANOVA will be used for range of motion (baseline and end of the treatment). Global rating scale of change analysis will be conducted using descriptive statistics. Intention-to-treat analysis will be adopted. Discussion As there is a paucity of longitudinal studies investigating the use of MWM in patients with RCRP, this study will help to better understand its role together with a structured exercise programme. Trial registration Clinical Trials Registry number NCT04175184. November, 2019.
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Affiliation(s)
- Rafael Baeske
- Science of Rehabilitation programme at Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil. .,, São Leopoldo, Brazil.
| | - Toby Hall
- School of Physiotherapy & Exercise Science, Curtin University, Kent Street, Bentley, Western Australia, 6102
| | - Marcelo Faria Silva
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil
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Immediate Effects of Ankle Joint Mobilization With Movement on Postural Control, Range of Motion, and Muscle Strength in Healthy Individuals: A Randomized, Sham-Controlled Trial. J Sport Rehabil 2020; 29:1060-1068. [PMID: 31754078 DOI: 10.1123/jsr.2019-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/30/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Ankle proprioception is one of the crucial components contributing to postural control. Although the effects of Mulligan's mobilization with movement (MWM) on postural control, ankle dorsiflexion range of motion (DFROM), and muscle strength in people with ankle disorders have previously been investigated, it is still unclear whether ankle MWM had ability to change postural control, DFROM, and muscle strength. OBJECTIVES To reveal pure effects of MWM on postural control, ankle DFROM, and muscle strength in healthy individuals. DESIGN A prospective, randomized, double-blinded, sham-controlled study. SETTING Musculoskeletal laboratory, Dokuz Eylul University, Turkey. PARTICIPANTS Forty students in good health recruited from a local university. INTERVENTIONS Mulligan's MWM or sham application over ankle joint. MAIN OUTCOME MEASURES The primary outcome was postural control and measured using limits of stability (LOS) test. The secondary outcomes were tibialis anterior muscle strength and ankle DFROM, which were measured using handheld dynamometer and weight-bearing lunge test, respectively. All outcomes were assessed before and immediately after intervention. RESULTS Left and right ankle DFROM and LOS overall score showed a statistically significant improvement compared with first measurement in both groups (P < .05). However, LOS time was significantly improved only in the MWM group (P < .05). Statistical analyses of between-group mean differences showed that Mulligan's MWM provided significant improvement in the LOS in forward-right direction compared with sham application (P = .03). CONCLUSIONS The results of this study suggest that the application of Mulligan's MWM on ankle joint might be beneficial to improve postural control in forward right direction in individuals with healthy ankles. On the other hand, both MWM and sham application were able to increase overall postural control and DFROM, and MWM had no superiority over sham application for increasing these 2 variables.
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Brindisino F, Ristori D, Lorusso M, Miele S, Pellicciari L, Rossettini G, Bonetti F, Heick JD, Testa M. Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities. Arch Physiother 2020; 10:16. [PMID: 32905154 PMCID: PMC7465722 DOI: 10.1186/s40945-020-00087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons. MATERIALS AND METHODS An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS. RESULTS Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent (n = 470) of the OMPTs and 80.5% (n = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy (p = < 0.001). Twenty point seven % of OMPTs (n = 106) and 4.7% of orthopaedic surgeon (n = 6) stated that the Lift off was the most specific test (p = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination (p < 0.001). CONCLUSION OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Simone Miele
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | | | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - John Duane Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
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Comparison of mobilization with supervised exercise for patients with subacromial impingement syndrome. Turk J Phys Med Rehabil 2020; 66:184-192. [PMID: 32760896 DOI: 10.5606/tftrd.2020.3649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/10/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives This study aims to investigate the effects of joint mobilization with supervised exercise in patients with subacromial impingement syndrome (SAIS). Patients and methods This prospective, randomized-controlled study included a total of 40 patients (18 males, 22 females; mean age 43.52 years; range, 27 to 67 years) with SAIS of more than six weeks between June 2014 and June 2015. The patients were randomly allocated into two groups: Group 1 (n=20) received joint mobilization and neuromuscular electrical stimulation and Group 2 (n=20) received a supervised exercise program and neuromuscular electrical stimulation. The outcome measures included the range of motion, pain intensity, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form-patient self-report section, Short Form-36, and Global Rating of Change Questionnaire. Pain was evaluated using the visual analog scale (VAS). Results In both groups, the mean VAS scores significantly decreased and the range of motion significantly increased after treatment (p<0.05). Both joint mobilization and supervised exercise combined with neuromuscular electrical stimulation led to a significant improvement in function in patients with SAIS (p<0.05), although it did not significantly differ between the groups (p>0.05). Patient satisfaction with treatment was similar in both groups (p=0.28). Conclusion Based on our study results, mobilization and supervised exercise yield comparable outcomes in patients with SAIS.
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Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan’s Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018. J Manipulative Physiol Ther 2019; 42:439-449. [DOI: 10.1016/j.jmpt.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022]
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Pain LAM, Baker R, Sohail QZ, Hebert D, Zabjek K, Richardson D, Agur AMR. The three-dimensional shoulder pain alignment (3D-SPA) mobilization improves pain-free shoulder range, functional reach and sleep following stroke: a pilot randomized control trial. Disabil Rehabil 2019; 42:3072-3083. [PMID: 30907155 DOI: 10.1080/09638288.2019.1585487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and purpose: Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whether a treatment group provided with current standard treatment plus the proposed "Three-dimensional Shoulder Pain Alignment" mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone.Methods: In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory).Results: Compared to controls (n = 10) the treatment group (n = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction (p < 0.05; Hedges g > 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86).Conclusions: The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment.Implications for rehabilitationAlthough three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management.The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement.The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain.
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Affiliation(s)
- Liza A M Pain
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Senior Services, Credit Valley Hospital-Trillium Health Partners, Mississauga, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ross Baker
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Debbie Hebert
- Toronto Rehabilitation Institute (University Centre), University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Karl Zabjek
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute (University Centre), University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Denyse Richardson
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Neuro-rehabilitation, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Anne M R Agur
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Menek B, Tarakci D, Algun ZC. The effect of Mulligan mobilization on pain and life quality of patients with Rotator cuff syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil 2019; 32:171-178. [PMID: 30248039 DOI: 10.3233/bmr-181230] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mulligan mobilization techniques cause pain and affect the function in patients with Rotator cuff syndrome. OBJECTIVE The aim of the study was to investigate the effect of Mulligan mobilization on pain and quality of life in individuals with Rotator cuff syndrome. METHODS This study was conducted on 30 patients with Rotator cuff syndrome. The patients were randomized into Mulligan and control group. All the patients participating in this study were treated with conventional physiotherapy. Additionally, the Mobilization with movement (MWM) technique was used in the Mulligan group. Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), goniometer for the normal range of motion (ROM) and Short Form-36 (SF-36) questionnaires were used for assessment. RESULTS Statistically significant improvement was found in the post-treatment VAS, DASH, SF-36, and ROM values significantly improved in both groups (p< 0.05). However, the Mulligan group showed much better results when compared to the control group in ROM, VAS, DASH (p< 0.05). In the SF-36 questionnaire, significant results were obtained for both groups, except the social function parameter. For the SF-36 parameters, both groups performed equally. CONCLUSIONS Mulligan mobilization was more effective than general treatment methods for pain as well as normal joint motion, DASH scoring and some parameters of SF-36 compared with general treatment methods.
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Affiliation(s)
- Burak Menek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Devrim Tarakci
- Department of Occupational Therapy, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Z Candan Algun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan’s mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008–2017. Physiotherapy 2019; 105:1-9. [DOI: 10.1016/j.physio.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/07/2018] [Indexed: 01/22/2023]
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Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial. Musculoskelet Sci Pract 2018; 38:91-98. [PMID: 30359870 DOI: 10.1016/j.msksp.2018.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Passive oscillatory mobilizations are often employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations. OBJECTIVES To investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead athletes with chronic shoulder pain. DESIGN Double-blind, controlled, within-subject, repeated-measures design. METHOD Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a 9-min, AP mobilization of the glenohumeral joint were compared with manual contact and no-contact interventions. Self-reported pain, pressure pain threshold (PPT), range of movement (ROM), muscle strength, and disability were measured immediately before and after each intervention. RESULTS/FINDINGS No significant differences were found among the treatment conditions in any of the variables investigated. A significantly greater mean decrease in self-reported shoulder pain was observed following treatment condition [0.63 (0.12, 1.14); p = 0.01]. PPT at the affected shoulder increased significantly following both the treatment [0.23 (-0.43, 0.02); p = 0.02] and manual contact [0.28 (-0.51, 0.04); p = 0.01] conditions. Shoulder AP joint mobilization also increased PPT at a distal, non-painful site [0.42 (-0.85, 0.01); p = 0.04]. No changes were observed in shoulder ROM or muscle strength. CONCLUSIONS This study found no superior effects in various pain or function-related outcome measures of a passive oscillatory anteroposterior mobilization applied to the glenohumeral joint compared to manual contact and no-contact interventions in overhead athletes with chronic shoulder pain. Some ability to modulate shoulder pain and local and widespread pain sensitivity was observed in the short term after the passive oscillatory anteroposterior mobilization.
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da Silva IH, da Silva Junior JM, Santos-de-Araújo AD, de Paula Gomes CAF, da Silva Souza C, de Souza Matias PHVA, Dibai-Filho AV. Intra- and inter-reliability of fleximetry in individuals with chronic shoulder pain. Phys Ther Sport 2018; 32:115-120. [DOI: 10.1016/j.ptsp.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022]
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Chuna manual therapy combined with acupuncture and cupping for frozen shoulder (adhesive capsulitis): Study protocol for a multicenter, randomized, patient-assessor blind, clinical trial. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis. Musculoskelet Sci Pract 2018; 33:1-10. [PMID: 29055216 DOI: 10.1016/j.msksp.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. OBJECTIVES To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. METHODS Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. RESULTS Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for "pain at present" (SMD -0.02; 95% CI: -0.35, 0.32) and "pain during movement" (SMD -0.12; 95% CI: -0.45, 0.21). CONCLUSION There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment.
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