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Ehsani F, Taghizadeh Delkhoush C, Mirmohammadkhani M, Ehyaie H. A Comparison of 2 Exercise Protocols in Athletes With Primary Subacromial Impingement Syndrome: A Randomized Clinical Trial. J Sport Rehabil 2024; 33:495-505. [PMID: 39069293 DOI: 10.1123/jsr.2023-0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 07/30/2024]
Abstract
CONTEXT To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. DESIGN A randomized and controlled clinical study. METHODS Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. RESULTS The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). CONCLUSIONS The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.
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Affiliation(s)
- Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hanna Ehyaie
- Department of Physical Therapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran
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Hernandez-Sanchez S, Roses-Conde J, Martinez-Llorens N, Ruiz D, Espejo-Antúnez L, Tomás-Rodríguez I, Toledo-Marhuenda JV, Albornoz-Cabello M. EFisioTrack System for Monitoring Therapeutic Exercises in Patients with Shoulder Orthopedic Injuries in a Hospital Setting: A Pilot Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4898. [PMID: 39123945 PMCID: PMC11314742 DOI: 10.3390/s24154898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
To assess the effects of the eFisioTrack monitoring system on clinical variables in patients with prescribed physiotherapy for shoulder injuries, twenty-four adult patients with shoulder orthopaedic injuries who underwent physical therapy treatment in a hospital setting participated in the study (twelve in the experimental group and twelve as controls). Clinical outcome measures were shoulder function and pain (Constant-Murley Score and Disabilities of the Arm, Shoulder, and Hand or DASH score). Each variable was measured by a blinded physiotherapist at baseline and at one month follow-up. Patients performed the prescribed exercises either supervised by the physiotherapist (control group) or in a separate room without therapist supervision (experimental group). There were no statistically significant differences between groups before treatment or at follow-up for any outcomes (p ≥ 0.05). There was a statistically significant decrease (p ≤ 0.05) of at least 10 points in both groups for the DASH score at follow-up. Differences in the total score and subjective components of the Constant-Murley were also evidenced within groups. The use of the eFisioTrack system showed similar results in clinical measures compared to those performed under the direct supervision of the physiotherapist. This approach might be suitable for providing an effective shoulder exercise program at home.
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Affiliation(s)
- Sergio Hernandez-Sanchez
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Jorge Roses-Conde
- Rehabilitation Service, General University Hospital of Elche, Carrer Almazara, 11, 03203 Alicante, Spain; (J.R.-C.); (N.M.-L.)
| | - Neus Martinez-Llorens
- Rehabilitation Service, General University Hospital of Elche, Carrer Almazara, 11, 03203 Alicante, Spain; (J.R.-C.); (N.M.-L.)
| | - Daniel Ruiz
- Department of Computer Technology, University of Alicante, Carrer de Sant Vincent S/N, 03690 Alicante, Spain;
| | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06071 Badajoz, Spain;
| | - Isabel Tomás-Rodríguez
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Jose-Vicente Toledo-Marhuenda
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, San Fernando, 4, 41009 Sevilla, Spain;
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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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Augusto DD, Scattone Silva R, Pinheiro DP, Sousa CDO. Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey. PLoS One 2024; 19:e0301326. [PMID: 38625895 PMCID: PMC11020769 DOI: 10.1371/journal.pone.0301326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/14/2024] [Indexed: 04/18/2024] Open
Abstract
The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.
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Affiliation(s)
- Denise Dal’Ava Augusto
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Scattone Silva
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Rehabilitation Sciences, Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Débora Pereira Pinheiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Catarina de Oliveira Sousa
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Marc T, Morana C. Effectiveness of a joint mobilizations protocol for shoulder subacromial pain syndrome: A pilot study. J Bodyw Mov Ther 2024; 38:574-582. [PMID: 38763611 DOI: 10.1016/j.jbmt.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Subacromial pain syndrome (SPS) is the most frequent shoulder pathology. The aims of this prospective randomized study were to evaluate the effects of some specific shoulder joint mobilizations ("spin correction"), and the effectiveness of a rehabilitation program, named Shoulder Global Concept, in SPS patients. METHODS 45 patients with SPS were randomly assigned to two groups, to benefit from a different first session of mobilizations: the experimental group received all specific mobilizations, while the control group received the same program but without the spin correction mobilizations. The second session was identical for both groups, with all specific mobilizations. Before and after the first two sessions, range of motion (ROM) in flexion, abduction, external and internal rotations, pain and functional status with Constant score and Quick Dash were evaluated. Evaluation was repeated with 24 patients after 11 rehabilitation sessions. Rehabilitation with Shoulder Global Concept included 13 mobilizations aiming at improving the ROM with passive and active-assisted mobilizations, static stretching, and muscle strengthening. RESULTS All ROM were improved at the end of the first session for both groups, but significantly more in the experimental group for glenohumeral (GH) abduction and external rotation (p < 0.05). Functional scores, pain and strength were significantly improved after 11 rehabilitation sessions with the Shoulder Global Concept. CONCLUSION This manual therapy method was able to improve shoulder mobility in one session. The additional joint mobilizations (spin correction) specifically increased GH abduction and external rotation. Rehabilitation of SPS with Shoulder Global Concept allowed to improve functional capacity and decrease pain.
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Affiliation(s)
- Thierry Marc
- Centre de Rééducation Spécialisé, Montpellier, France
| | - Claire Morana
- Centre de Rééducation Spécialisé, Montpellier, France.
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Wang S, Chapple C, Farrell G, Quinn D, Tumilty S, Ribeiro DC. Dosage of joint mobilization for the management of patients with rotator cuff-related shoulder pain: A scoping review. Musculoskelet Sci Pract 2024; 70:102903. [PMID: 38412572 DOI: 10.1016/j.msksp.2023.102903] [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: 03/14/2023] [Revised: 11/26/2023] [Accepted: 12/15/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Evidence supporting type and dosage of joint mobilizations and rationale for selecting joint mobilization dosage for patients with rotator cuff-related shoulder pain are limited. OBJECTIVES This scoping review aimed to systematically map the type and dosage of joint mobilizations used in previous trials for managing patients with rotator cuff-related shoulder pain; and summarize the rationale for adopting a specific joint mobilization dosage. METHODS We searched six databases. We included randomised controlled trials using joint mobilization for patients with rotator cuff-related shoulder pain. We extracted data regarding technique, treatment joint mobilization dosages and rationale for a specific dosage. RESULTS We included 32 studies. Most studies did not or partially report technique (67%) and within-session dosage (64%) of passive joint mobilization. Overall treatment was fully reported in 95% of studies. The dosage used for passive joint mobilization was heterogeneous (ranging from grade I to grade V). Most studies (85%) did not or partially report technique of mobilization with movement (MWM), whereas within-session and overall treatment dosages were fully reported in more than 85% of studies. Three sets of 10 repetitions were commonly used within-session dosage for MWM. We found very limited information on the rationale for selecting dosage of joint mobilization. CONCLUSION We found limited information about the dosage or the rationale for selecting joint mobilization, with a heterogeneous dosage being tested across trials. Our findings highlight the importance of detailed reporting for dosage and rationale for selecting a specific dosage of joint mobilization.
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Affiliation(s)
- Sizhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand; Division of Physiotherapy, Department of Health Sciences, Brunel University London, Uxbridge, London, UK; Centre for Physical Activity in Health and Disease (CPAHD), Brunel University London, Uxbridge, London, UK
| | - Cathy Chapple
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Gerard Farrell
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Dusty Quinn
- Back in Motion Ltd, Dunedin, Otago, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand.
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Tauqeer S, Arooj A, Shakeel H. Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement syndrome: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:192. [PMID: 38431547 PMCID: PMC10908164 DOI: 10.1186/s12891-024-07294-4] [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: 08/17/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The current study aimed to measure the effectiveness of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome to improve functional capacity, pain, and scapular range of motion. METHODS This is a single-blinded randomized controlled trial. Thirty-two participants with chronic shoulder impingement syndrome were randomly allocated into two groups. Both groups received stretching and strengthening exercises while the treatment group was given manual therapy additionally. Treatment was started after the patients signed an informed consent form. The data were collected from the University of Lahore Teaching Hospital between March 2022 and December 2022. The study aimed to measure pain using a numeric pain rating scale, functional capacity was assessed by the disability of the arm and shoulder, and goniometry was used for scapular ranges, i.e., scapular protraction and upward rotation. Each treatment session lasted 45 min for the treatment group and 30 min for the control group. The treatment comprised five days a week for four weeks, after which post-intervention measurements were taken. RESULTS Thirty-two participants were enrolled in the study, and 16 were divided into each group. The mean age of the participants in the treatment group was 38.19 ± 7.31 while the comparison group was 35.69 ± 7.98. An independent sample t-test was run on the data with a 95% confidence interval, statistically significant results were obtained, i.e., p-value < 0.05, post-intervention in the treatment group. Both groups have significantly improved functional capacity and scapular protraction (p < 0.005), however, pain and scapular upward rotation were not found statistically significant in the control group (p > 0.05). CONCLUSION The addition of manual therapy along with exercise therapy showed clinical and statistical significant results for pain, functional capacity, and scapular range of motion. It demonstrated superior effects than exercise therapy alone for the chronic condition of SIS. TRIAL REGISTRATION The trial was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir/ ) with the registration number: IRCT20230526058291N1, (Date: 12/08/2023).
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Affiliation(s)
- Sana Tauqeer
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Ayesha Arooj
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan.
| | - Hammad Shakeel
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
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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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Moradi M, Shadmehr A, Fischer T, Attarbashi Moghaddam B, Ebrahimzade MH, Jalaei S. Comparison of the efficacy of manual treatment according to fascial distortion model versus joint mobilization in patients with shoulder impingement: A randomized clinical trial. J Bodyw Mov Ther 2023; 36:410-416. [PMID: 37949593 DOI: 10.1016/j.jbmt.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/19/2023] [Accepted: 06/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, but to date no study has been conducted to compare its' effect in comparison with joint mobilization on patients with shoulder impingement syndrome. OBJECTIVE The present study aims to compare the efficacy of the FDM versus joint mobilization in pain intensity, pain-free abduction range of motion and function of patients with shoulder impingement syndrome. DESIGN single-blind, parallel-arm randomized controlled trial. METHODS 26 patients diagnosed with shoulder impingement syndrome were equally randomized into 2 groups: manual treatment according to the FDM, and joint mobilization of the shoulder complex. All patients received 3 intervention sessions every other day. Pain intensity (by visual analogue scale), pain-free abduction range of motion (by goniometry) and function (by Persian version of shoulder pain and disability index) were measured before and after every session and at follow-up 2 weeks later. Patients' satisfaction with treatment was also measured (by a 4-point Likert scale) at follow-up. RESULTS FDM therapy group showed statistically significant greater pain reduction (P = 0.014) and range of motion increment (P = 0.044) than joint mobilization group after intervention, while only range of motion maintained the difference at follow-up (P = 0.034). Function improvement was not statistically different after the intervention (P = 0.582) and at follow-up (P = 0.094). There was no difference in patients' satisfaction with treatment between groups (P > 0.05). CONCLUSION The FDM is a safe and effective treatment approach with comparable results to joint mobilization in patients with shoulder impingement syndrome.
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Affiliation(s)
- Mahmood Moradi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Azade Shadmehr
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Thorsten Fischer
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Agora Interdisziplinäres Behandlungszentrum, D-30163, Hannover, Rühmkorffstraße 1, Germany
| | | | | | - Shohre Jalaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Cooper K, Alexander L, Brandie D, Brown VT, Greig L, Harrison I, MacLean C, Mitchell L, Morrissey D, Moss RA, Parkinson E, Pavlova AV, Shim J, Swinton PA. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technol Assess 2023; 27:1-389. [PMID: 37929629 PMCID: PMC10641714 DOI: 10.3310/tfws2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review questions (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases (n = 9), trial registries (n = 6), grey literature databases (n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021. Results Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect sizeResistance:Flexibility = 0.18 [95% CrI 0.07 to 0.29]) and proprioception (effect sizeResistance:Proprioception = 0.16 [95% CrI -1.8 to 0.32]); (2) when performing strengthening exercise it may be most beneficial to combine concentric and eccentric modes (effect sizeEccentricOnly:Concentric+Eccentric = 0.48 [95% CrI -0.13 to 1.1]; and (3) exercise may be most beneficial when combined with another conservative modality (e.g. injection or electro-therapy increasing effect size by ≈0.1 to 0.3). Mixed-method review - 94 studies (11 qualitative) provided evidence that exercise interventions for tendinopathy can largely be considered feasible and acceptable, and that several important factors should be considered when prescribing exercise for tendinopathy, including an awareness of potential barriers to and facilitators of engaging with exercise, patients' and providers' prior experience and beliefs, and the importance of patient education, self-management and the patient-healthcare professional relationship. Limitations Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made. Conclusion The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence. Future work There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes. Study registration This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review). Funding This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kay Cooper
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - David Brandie
- Sportscotland Institute of Sport, Airthrey Road, Stirling, UK
| | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Isabelle Harrison
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Colin MacLean
- Library Services, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Laura Mitchell
- NHS Grampian, Physiotherapy Department, Ellon Health Centre, Schoolhill, Ellon, Aberdeenshire, UK
| | - Dylan Morrissey
- William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, UK
| | - Rachel Ann Moss
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Eva Parkinson
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | | | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
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11
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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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12
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López-de-Celis C, Caudevilla-Polo S, Pérez-Bellmunt A, González-Rueda V, Bueno-Gracia E, Estébanez-de-Miguel E. Effect of Scapular Fixation on Lateral Movement and Scapular Rotation during Glenohumeral Lateral Distraction Mobilisation. Healthcare (Basel) 2023; 11:1829. [PMID: 37444663 DOI: 10.3390/healthcare11131829] [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: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation. METHODS Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation. RESULTS The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application. CONCLUSIONS Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.
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Affiliation(s)
- Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | | | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Elena Bueno-Gracia
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
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13
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Naseri F, Dadgoo M, Pourahmadi M, Amroodi MN, Azizi S, Tabrizian P, Amiri A. Dry needling in a multimodal rehabilitation protocol following rotator cuff repair surgery: study protocol for a double-blinded randomized sham-controlled trial. BMC Musculoskelet Disord 2023; 24:330. [PMID: 37101278 PMCID: PMC10131318 DOI: 10.1186/s12891-023-06269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/23/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rotator cuff tear (RCT) is one of the main causes of shoulder pain and dysfunction. Rotator cuff repair (RCR) is a common surgical procedure for the management of RCTs. Presence of myofascial trigger points (MTrP) as a result of surgical procedure can aggravate postoperative shoulder pain. The purpose of this protocol is to describe a randomized controlled trial design to evaluate the effect of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) within a multimodal rehabilitation protocol following RCR surgery. METHODS Forty-six participants aged 40-75 will be recruited having postoperative shoulder pain after RCR and meeting the inclusion criteria. Participants will be randomly divided into 2 groups: One group will undergo MTrP-DN, manual therapy, exercise therapy and electrotherapy and the other will receive sham dry needling (S-DN), manual therapy, exercise therapy and electrotherapy. This protocol will cover 4 weeks of intervention. The primary outcome measure will be the Numeric Pain Rating Scale (NPRS) for pain. Secondary outcome measures will be Shoulder Pain and Disability Index (SPDI), range of motion (ROM), strength and adverse events. DISCUSSION This is the first study to investigate the use of 4 sessions of MTrP-DN in combination with a multimodal rehabilitation protocol for postoperative shoulder pain, restriction, weakness and dysfunction following RCR. The results of this study may help to determine the effect of MTrP-DN on various outcomes after RCR surgery. TRIAL REGISTRATION This trial was registered at the ( https://www.irct.ir ), (IRCT20211005052677N1) on 19/2/2022.
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Affiliation(s)
- Faeze Naseri
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
| | - Mehdi Dadgoo
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran.
| | - Mohammadreza Pourahmadi
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
| | - Morteza Nakhaei Amroodi
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Azizi
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
| | - Pouria Tabrizian
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amiri
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
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14
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Jafarian Tangrood Z, Spontelli Gisselman A, Sole G, Cury Ribeiro D. Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2192620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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15
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Azin Z, Kamali F, Salehi Dehno N, Abolahrari-Shirazi S. Comparison of Manual Therapy Technique to Therapeutic Exercise in the Treatment of Patients With Subacromial Impingement Syndrome: A Randomized Clinical Trial. J Manipulative Physiol Ther 2023; 46:98-108. [PMID: 37777940 DOI: 10.1016/j.jmpt.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of manual therapy to therapeutic exercise on shoulder pain, disability, and range of motion (ROM) in patients with subacromial impingement syndrome (SAIS). METHODS Sixty patients with SAIS were randomly assigned into the manual therapy (MT) and therapeutic exercise (TE) groups. Patients in the MT group were treated with joint mobilization, which was applied to the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints, and trigger point (TrP) inactivation using ischemic compression. Patients in the TE group performed therapeutic exercises. Shoulder pain, disability and active ROM (elevation, external rotation, and internal rotation) were assessed by the visual analog scale, the Shoulder Pain and Disability Index, and a goniometer, respectively. The outcomes were measured at baseline, after the intervention, and 1 month after the intervention. RESULTS After the treatment, both groups had significant improvements in shoulder pain, disability, and ROM (P < .05). The MT group experienced a greater reduction in shoulder pain than the TE group (P < .001). However, in disability and ROM, both groups exhibited similar improvements in post-treatment and follow-up periods. CONCLUSION Both MT and TE were effective in improving shoulder pain, disability, and ROM in patients with SAIS. Greater improvement in shoulder pain was observed in the MT group.
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Affiliation(s)
- Zeynab Azin
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Salehi Dehno
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Abolahrari-Shirazi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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16
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Gutiérrez-Espinoza H, Cuyul-Vásquez I, Olguin-Huerta C, Baldeón-Villavicencio M, Araya-Quintanilla F. Effectiveness of Glenohumeral Joint Mobilization on Range of Motion and Pain in Patients With Rotator Cuff Disorders: A Systematic Review and Meta-Analysis. J Manipulative Physiol Ther 2023; 46:109-124. [PMID: 37422746 DOI: 10.1016/j.jmpt.2023.05.009] [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: 08/17/2022] [Revised: 11/20/2022] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the effectiveness of glenohumeral joint mobilization (JM) on range of motion and pain intensity in patients with rotator cuff (RC) disorders. METHODS An electronic search was performed in the MEDLINE, CENTRAL, Embase, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that investigated the effect of glenohumeral JM techniques with or without other therapeutic interventions on range of motion, pain intensity, and shoulder function in patients older than 18 years with RC disorders. Two authors independently performed the search, study selection, and data extraction, and assessed risk of bias. Grades of Recommendation Assessment, Development and Evaluation ratings were used to evaluate the quality of evidence in this study. RESULTS Twenty-four trials met the eligibility criteria, and 15 studies were included in the quantitative synthesis. At 4 to 6 weeks, for glenohumeral JM with other manual therapy techniques vs other treatments, the mean difference (MD) for shoulder flexion was -3.42° (P = .006), abduction 1.54° (P = .76), external rotation 0.65° (P = .85), and Shoulder and Pain Disability Index score 5.19 points (P = .5), and standard MD for pain intensity was 0.16 (P = .5). At 4 to 5 weeks, for the addition of glenohumeral JM to an exercise program vs exercise program alone, the MD for the visual analog scale was 0.13 cm (P = .51) and the Shoulder and Pain Disability Index score was -4.04 points (P = .01). CONCLUSION Compared with other treatments or an exercise program alone, the addition of glenohumeral JM with or without other manual therapy techniques does not provide significant clinical benefit with respect to shoulder function, range of motion, or pain intensity in patients with RC disorders. The quality of evidence was very low to high according to Grades of Recommendation Assessment, Development and Evaluation ratings.
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Affiliation(s)
| | - Iván Cuyul-Vásquez
- Therapeutic Process Department, Faculty of Health, Temuco Catholic University, Temuco, Chile
| | | | | | - Felipe Araya-Quintanilla
- School of Kinesiology, Faculty of Dentistry and Sciences of Rehabilitation, San Sebasti an University Santiago, Chile.
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17
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de-Queiroz JHM, de-Medeiros MB, de-Lima RN, Cerdeira DDQ. Exercise for rotator cuff tendinopathy. Rev Bras Med Trab 2022; 20:498-504. [PMID: 36793454 PMCID: PMC9904825 DOI: 10.47626/1679-4435-2022-698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022] Open
Abstract
Rotator cuff tendinopathy is among the main causes of shoulder pain. It is characterized by lesions without rupture caused by overload, work-related repetitive strain injury, or metabolic changes such as diabetes affecting one or more tendons, which cause pain, morphological alterations, and disability. This study aimed to evaluate the effects of exercise-based therapy on shoulder pain reduction and functioning improvement in patients with rotator cuff tendinopathy. This was a systematic review. Data were collected from randomized controlled trials retrieved from PubMed, Biblioteca Virtual em Saúde, PEDro, Web of Science, Scopus, and CENTRAL metasearch engines. The PEDro scale was used to evaluate the methodological quality of the selected studies. Eccentric exercise, conventional exercise, scapular and rotator cuff muscle strengthening, rotator cuff strengthening plus pectoralis major strengthening, high-load training, and low-load training were effective for the outcomes investigated in this study. Furthermore, goniometry, visual analogue scales, the Constant Murley score, the Disabilities of the Arm, Shoulder and Hand questionnaire, and the Shoulder Pain and Disability Index were constantly used to measure pain and functioning. Therapeutic exercises should be performed in this population, and new randomized controlled trials should be conducted with the goal of achieving the same outcome. The International Classification of Functioning, Disability and Health should be increasingly used in studies addressing patient functioning.
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Affiliation(s)
- Jeffeson Hildo Medeiros de-Queiroz
- Departamento de Fisioterapia, Universidade Federal do Ceará,
Fortaleza, CE, Brazil ,Correspondence address: Jeffeson Hildo Medeiros de-Queiroz - Rua
Iguape, 172 - Bairro Parangaba - CEP: 60720-490 - Fortaleza (CE), Brazil -
E-mail:
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18
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Wang S, Chapple CM, Quinn D, Tumilty S, Ribeiro DC. Dosage of joint mobilisation for the management of rotator cuff-related shoulder pain: protocol for a scoping review. BMJ Open 2022; 12:e056771. [PMID: 36691247 PMCID: PMC9171208 DOI: 10.1136/bmjopen-2021-056771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/09/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive. OBJECTIVES To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage. METHODS AND ANALYSIS We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis. ETHICS AND DISSEMINATION Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.
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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
| | - Cathy M Chapple
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Steve Tumilty
- 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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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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Blanco-Díaz M, Ruiz-Redondo R, Escobio-Prieto I, De la Fuente-Costa M, Albornoz-Cabello M, Casaña J. A Systematic Review of the Effectiveness of Dry Needling in Subacromial Syndrome. BIOLOGY 2022; 11:biology11020243. [PMID: 35205109 PMCID: PMC8869493 DOI: 10.3390/biology11020243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Dry needling, used by physical therapists, is a treatment modality used for the management of musculoskeletal pain. It is a technique in which a fine needle is used to penetrate the skin, subcutaneous tissues and muscles, with the aim of mechanically disrupting the inner tissues. This technique is called dry needling as the procedure does not involve the injection of any substance. Subacromial syndrome is defined as any kind of non-traumatic, usually unilateral, shoulder problem that causes pain around the acromion, that usually gets worse during or after lifting the arm. It should not be treated with surgical methods as the first option, but with different physiotherapy techniques. In this review, an overview of the effects of dry needling combined with conventional physiotherapy in patients with subacromial syndrome is presented. One of the key focal points is that dry needling combined with physiotherapy is effective and safe in reducing the pain and disability caused by this pathology. Abstract Our aim was to evaluate the effectiveness of dry needling (DN) combined with conventional physiotherapy in the recovery of patients with subacromial syndrome (SAS). A search was made of the main open access health science databases. The publication date was not limited for systematic reviews but was for randomized clinical trials (RCTs), which were limited to the last five years (from 2016) in English or in Spanish. Ninety-four studies were selected. In order to assess the quality of the studies, the JADAD scale or Oxford quality scoring system was used. A total of 402 patients were analyzed in all the studies in which the application of conventional physiotherapy was compared to the DN, either in a combination or in isolation. Improvements were obtained in pain intensity (Visual Analogic Scale—VAS), Range of Movement (ROM), Pressure Pain Threshold (PPT), functionality with Disabilities of the Arm, Shoulder and Hand (DASH) and the Shoulder Pain and Disability Index (SPADI), and in the cost–benefit ratio. DN is effective and safe in reducing the pain and disability produced by SAS, with the best combination of treatment turning out to be conventional physiotherapy together with DN, obtaining more stable and longer-lasting benefits than merely applying the techniques in isolation.
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Affiliation(s)
- María Blanco-Díaz
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Asturias, Spain; (M.B.-D.); (R.R.-R.); (M.D.l.F.-C.)
| | - Rubén Ruiz-Redondo
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Asturias, Spain; (M.B.-D.); (R.R.-R.); (M.D.l.F.-C.)
| | - Isabel Escobio-Prieto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
- Correspondence:
| | - Marta De la Fuente-Costa
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Asturias, Spain; (M.B.-D.); (R.R.-R.); (M.D.l.F.-C.)
| | - Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
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Guerra-Rodríguez D, Rozo L, Basilio D, Guerrero-Henriquez J. In vivo measurements of glenohumeral distraction technique performed in three different joint positions. J Man Manip Ther 2021; 29:353-359. [PMID: 33761826 PMCID: PMC8725771 DOI: 10.1080/10669817.2021.1904350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Distraction techniques are an important part of the manual approach in the glenohumeral joint; however, there is controversy regarding the initial joint position to maximize separation of joint surfaces.Objective: To identify, through an in vivo exploration, the behavior of the coracohumeral distance (CHD) during the application of a short lever arm grade III distraction technique on the humeral head, executed in three different glenohumeral positions (zero position (P0), rest position (RP) and 90º abduction position with maximum external rotation (ABD+ER)).Methods: 15 participants were selected. A physical therapist executed grade III distraction techniques in described joint positions. Ultrasound was used to visualize the differences in CHD. Statistical analysis included interclass correlation coefficients (ICC) and repeated measurements of ANOVA.Results: The range of ICC values was 0.740 and 0.948. The differences in CHD were 5.74 ± 0.51 mm, 3.97 ± 0.24 mm, and 0.64 ± 0.02 mm, for P0, RP and ABD+ER during application of distraction technique, respectively. There were differences between P0 and RP with ABD+ER (P < 0.001), and no differences between P0 and RP.Conclusion: Initial joint position of application influences the separation of the articular surfaces, being wider in the zero and rest positions.
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Affiliation(s)
- Diego Guerra-Rodríguez
- Biomedical Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
| | - Liliana Rozo
- Postgraduate Department of Manual Therapy, Faculty of Rehabilitation Sciences, Andres Bello University, Santiago, Chile
| | - Daniel Basilio
- Kinetic-K Integral Therapy and Training Center, Antofagasta, Chile
| | - Juan Guerrero-Henriquez
- Rehabilitation and Human Movement Sciences Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
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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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Progressive Resistance Exercises plus Manual Therapy Is Effective in Improving Isometric Strength in Overhead Athletes with Shoulder Impingement Syndrome: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9945775. [PMID: 34307681 PMCID: PMC8266437 DOI: 10.1155/2021/9945775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022]
Abstract
Reduction in isometric strength of the scapulohumeral muscles is a commonly seen impairment in overhead athletes afflicted with shoulder impingement syndrome (SIS). The purpose of this study was to compare the effects of two different treatment programs: progressive resistance exercises plus manual therapy (PRE plus MT) and motor control exercises (MCE), on isometric strength of upper trapezius (UT), middle trapezius (MTr), lower trapezius (LT), serratus anterior (SA), supraspinatus (Supr.), anterior deltoid (A.D), and latissimus dorsi (LD). 80 male university-level overhead athletes clinically diagnosed with SIS were randomly allocated into either of the two groups: PRE plus MT and MCE group. Athletes in the PRE plus MT group underwent graduated exercises with resistance elastic band, stretching exercises, and mobilization of the thoracic and shoulder joints. MCE group was submitted to motor control exercises in varied planar positions. Athletes in both groups underwent management 3 times a week for 8 weeks. Isometric strength of UT, MTr, LT, Supr, A.D, SA, and LD was measured at three-time points: baseline, 4th week, and 8th week. Relative to baseline, both interventions were found to be effective in increasing and optimizing the isometric strength of muscles (p < 0.05) except for supraspinatus in the MCE group (p > 0.05). However, athletes in PRE plus MT group presented a more pronounced increase in isometric strength than those in the MCE group. Between groups analysis found the largest isometric strength improvement in PRE plus MT group for A.D, followed by Supr. and UT muscles (p < 0.05; effect size: 0.39 to 0.40). The study concluded that compared to MCE, PRE plus MT provides greater improvement in the isometric strength of scapulohumeral muscles.
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Supervised Training Compared With No Training or Self-training in Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102:2428-2441.e10. [PMID: 33930326 DOI: 10.1016/j.apmr.2021.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the effects of supervised training in adults with subacromial pain syndrome. DATA SOURCES Embase, MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database were searched from inception to March 2020. STUDY SELECTION Independent reviewers selected randomized controlled trials comparing supervised training with (1) no training or (2) self-training in adults with subacromial pain syndrome lasting for at least 1 month. Critical outcomes were shoulder pain, function, and patient-perceived effect. Important outcomes included other potential benefits and adverse events at 3-month follow-up. DATA EXTRACTION Two independent reviewers extracted data for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool 1, and certainty of evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE). DATA SYNTHESIS Ten studies (n=597, 43% female) were included. Supervised training resulted in larger improvements than no training on pain (at rest: n=286; mean difference [MD], 1.68; 95% confidence interval [CI], 0.31-3.06 on 0-10 scale; during movement: n=353; MD, 1.84; 95% CI,0.91-2.76), function (n=396; standardized MD, 0.30; 95% CI, 0.07-0.52), and patient-perceived effect (n=118; risk ratio, 1.43; 95% CI, 0.87-2.34). Supervised training had potential benefits regarding quality of life, return to work, dropout, and training adherence, albeit more patients reported mild, transient pain after training. Supervised training and self-training showed equal improvements on pain (n=44) and function (n=76), with no data describing patient-perceived effect. Certainty of evidence was low for critical outcomes and low-moderate for other outcomes. CONCLUSIONS Supervised training might be superior to no training and equally effective as self-training on critical and important outcomes. Based on low-moderate certainty of evidence, these findings support a weak recommendation for supervised training in adults with subacromial pain syndrome.
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Sharma S, Ejaz Hussain M, Sharma S. Effects of exercise therapy plus manual therapy on muscle activity, latency timing and SPADI score in shoulder impingement syndrome. Complement Ther Clin Pract 2021; 44:101390. [PMID: 33901859 DOI: 10.1016/j.ctcp.2021.101390] [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] [Received: 07/26/2020] [Revised: 03/11/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The study aimed to compare the effects of exercise therapy plus manual therapy (ET plus MT) and exercise therapy (ET) alone on muscle activity, muscle onset latency timing and shoulder pain and disability index-Hindi (SPADI-H) score in athletes with shoulder impingement syndrome (SIS). MATERIALS AND METHOD Overhead male athletes diagnosed with SIS were randomly allocated into ET plus MT group(n = 40) and ET group(n = 40). Muscle activity, muscle onset latency timings and SPADI-H score were assessed. Both the groups performed 8 weeks of intervention and were evaluated at baseline, 4th and 8th weeks. RESULT ET plus MT group was more effective in increasing muscle activity, optimising latency timings and decreasing SPADI score when compared to ET group alone(p < 0.05). After treatment muscle activity and SPADI-H improved in both groups (p < 0.05). CONCLUSION ET plus MT was superior for improving muscle activity, muscle onset latency timing and SPADI score compared to ET alone.
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Affiliation(s)
- Saurabh Sharma
- Jamia Millia Islamia, Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, 110025, India.
| | - M Ejaz Hussain
- Jamia Millia Islamia, Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, 110025, India
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Ribeiro DC, Spiers K, Thomas L, Leilua K, Wilkes M, Norton S, Lamb SE. Monitoring, implementation and reporting of interventions in a selection of trials assessing exercise therapy for the management of shoulder subacromial pain: a cross-sectional investigation. BMJ Open 2021; 11:e044462. [PMID: 33593786 PMCID: PMC7888324 DOI: 10.1136/bmjopen-2020-044462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To review the reporting of monitoring and implementation of interventions in a selection of trials that assessed the effectiveness of manual therapy and exercise in the management of shoulder subacromial pain. DESIGN A review of trials assessing the effectiveness of manual therapy and exercise in the management of patients with shoulder subacromial pain. METHODS We included in our review a selection of 10 trials that were included in a Cochrane review and compared manual therapy and exercise intervention with another intervention. Trials were assessed independently by two reviewers using two checklists: the Template for Intervention Description and Replication (TIDieR) and the Health Behavior Change Consortium treatment fidelity (National Institutes of Health Behaviour Change Consortium/NIHBCC). RESULTS TIDieR overall scores for individual trials ranged from 11.1% to 45% and fidelity scores ranged from 7% to 50%. On average, trials scored the following within each domain of NIHBCC: study design 51%; training of providers 8%; treatment delivery 15%; treatment receipt 14% and treatment enactment 2.5%. CONCLUSIONS Little information about the monitoring, implementation and reporting of interventions was provided by trials and that is a barrier for implementing or replicating these interventions. The lack of information regarding the implementation of interventions needs to be taken into account when assessing whether effectiveness of interventions was impacted by their design or due to deviations from the protocol within trials.
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Affiliation(s)
- Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kate Spiers
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Laura Thomas
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kiriffi Leilua
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Matthew Wilkes
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Shontal Norton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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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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Kim SY, Dvir Z, Oh JS. The application of the Neurac technique vs. manual therapy in patients during the acute phase of subacromial impingement syndrome: A randomized single-blinded controlled trial. J Back Musculoskelet Rehabil 2020; 33:645-653. [PMID: 31594195 DOI: 10.3233/bmr-170884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUD Although the effect of exercise in patients during the subacute and/or chronic subacromial impingement syndrome has been reported, only a few studies have examined the effect of pain free exercise in the acute phase of this disorder. OBJECTIVE To compare the effect of training using the Neurac technique which combines body segments suspension and vibration vs. manual therapy, on various relevant outcome parameters in patients with acute subacromial impingement syndrome (PASIS). METHOD Twenty-six patients underwent a 4 week intervention program. Using random assignment, half of the patients were treated using the Neurac device while the other half was treated using manual therapy. The outcome parameters consisted of shoulder pain, shoulder function, range of motion (ROM) and the isokinetic strength of the external and internal rotators at 60 and 180∘/s. RESULTS Following either modes of interventions, the pain, function, and ROM improved significantly compared to pre-intervention levels in both groups. Time-by-group interaction was observed for the rotational strength which increased significantly and exclusively in the Neurac group. CONCLUSIONS Given its positive effect on shoulder pain, function, ROM and the isokinetic strength of the external and internal rotators, we recommend the application of the Neurac technique in PASIS.
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Affiliation(s)
- Soo-Yong Kim
- Department of Physical Therapy, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangsam-do, Korea
| | - Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Korea
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Malliaras P, Johnston R, Street G, Littlewood C, Bennell K, Haines T, Buchbinder R. The Efficacy of Higher Versus Lower Dose Exercise in Rotator Cuff Tendinopathy: A Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil 2020; 101:1822-1834. [DOI: 10.1016/j.apmr.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 01/29/2023]
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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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Naunton J, Street G, Littlewood C, Haines T, Malliaras P. Effectiveness of progressive and resisted and non-progressive or non-resisted exercise in rotator cuff related shoulder pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2020; 34:1198-1216. [DOI: 10.1177/0269215520934147] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Synthesize evidence regarding effectiveness of progressive and resisted or non-progressive and non-resisted exercise compared with placebo or no treatment, in rotator cuff related pain. Data sources: English articles, searched in Cochrane CENTRAL, MEDLINE, EMBASE and CINAHL databases up until May 19, 2020. Methods: Randomized controlled trials in people with rotator cuff related pain comparing either progressive and resisted exercise or non-progressive and non-resisted exercise, with placebo or no treatment were included. Data extracted independently by two authors. Risk of bias appraised with the Cochrane Collaboration tool. Results: Seven trials (468 participants) were included, four trials (271 participants) included progressive and resisted exercise and three trials (197 participants) included non-progressive or non-resisted exercise. There was uncertain clinical benefit for composite pain and function (15 point difference, 95% CI 9 to 21, 100-point scale) and pain outcomes at >6 weeks to 6 months with progressive and resisted exercise compared to placebo or no treatment (comparison 1). For non-progressive or non-resisted exercise there was no significant benefit for composite pain and function (4 point difference, 95% CI −2 to 9, 100-point scale) and pain outcomes at >6 weeks to 6 months compared to placebo or no treatment (comparison 2). Adverse events were seldom reported and mild. Conclusions: There is uncertain clinical benefit for all outcomes with progressive and resisted exercise and no significant benefit with non-progressive and non-resisted exercise, versus no treatment or placebo at >6 weeks to 6 months. Findings are low certainty and should be interpreted with caution.
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Affiliation(s)
- Josh Naunton
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Gabrielle Street
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Chris Littlewood
- Research Institute for Primary and Health Sciences, David Weatherall Building, Keele University, Staffordshire
| | - Terrence Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, 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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Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review. J Orthop Sports Phys Ther 2020; 50:285-a12. [PMID: 32476583 DOI: 10.2519/jospt.2020.9152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. DESIGN Scoping review. LITERATURE SEARCH We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. STUDY SELECTION CRITERIA We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. DATA SYNTHESIS We performed a qualitative synthesis that identified items included in patient advice and education. RESULTS Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. CONCLUSION While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.
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Major DH, Røe Y, Grotle M, Jessup RL, Farmer C, Småstuen MC, Buchbinder R. Content reporting of exercise interventions in rotator cuff disease trials: results from application of the Consensus on Exercise Reporting Template (CERT). BMJ Open Sport Exerc Med 2019; 5:e000656. [PMID: 31908837 PMCID: PMC6936978 DOI: 10.1136/bmjsem-2019-000656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background Exercise interventions are frequently recommended for patients with rotator cuff disease, but poor content reporting in clinical trials of exercise limits interpretation and replication of trials and clinicians’ ability to deliver effective exercise protocols. The Consensus on Exercise Reporting Template (CERT) was developed to address this problem. Objective To assess completeness of content reporting of exercise interventions in randomised controlled trials for patients with rotator cuff disease and the inter-rater reliability of the CERT. Design Critical appraisal. Methods Independent pairs of reviewers applied the CERT to all 34 exercise trials from the most recent Cochrane Review evaluating the effect of manual therapy and exercise for patients with rotator cuff disease. We used the CERT Explanation and Elaboration Statement to guide assessment of whether each of the 19-item criteria were clearly described (score 0–19; higher scores indicate better reporting). Percentage agreement and the prevalence and bias adjusted kappa (PABAK) coefficient were used to measure inter-rater reliability. Results The median CERT score was 5 (range 0–16). Percentage agreement was high for 15 items and acceptable for 4 items. The PABAK coefficient indicated excellent (5 items), substantial (11 items) and moderate (3 items) inter-rater agreement. Conclusion The description of exercise interventions for patients with rotator cuff disease in published trials is poorly reported. Overall, the inter-rater reliability of the CERT is high/acceptable. We strongly encourage journals to mandate use of the CERT for papers reporting trial protocols and results investigating exercise interventions.
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Affiliation(s)
- Daniel H Major
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Yngve Røe
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Rebecca L Jessup
- Cabrini Institute, Monash Department of Clinical Epidemiology, Melbourne, Victoria, Australia.,Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
| | - Caitlin Farmer
- Cabrini Institute, Monash Department of Clinical Epidemiology, Melbourne, Victoria, Australia.,Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
| | - Milada Cvancarova Småstuen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Rachelle Buchbinder
- Cabrini Institute, Monash Department of Clinical Epidemiology, Melbourne, Victoria, Australia.,Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
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Barrett E, Conroy C, Corcoran M, Sullivan KO, Purtill H, Lewis J, McCreesh K. An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series. J Hand Ther 2019; 31:301-307. [PMID: 29217293 DOI: 10.1016/j.jht.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A case series was carried out. INTRODUCTION There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. PURPOSE OF THE STUDY To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. METHODS People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. RESULTS Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P < .001). Effect sizes ranged from 0.78-1.16 in the shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. DISCUSSION/CONCLUSION Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture.
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Affiliation(s)
- Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Carmela Conroy
- Physiotherapy Department, St. John's Hospital, Limerick, Ireland
| | - Marie Corcoran
- Physiotherapy Department, Midland Regional Hospital, Portlaoise, Ireland
| | - Kieran O' Sullivan
- Sports Spine Centre, Aspetar Sports and Orthopaedic Hospital, Doha, Qatar
| | - Helen Purtill
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Jeremy Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland; Department of Allied Health Professions and Midwifery, University of Hertfordshire, Hertfordshire, UK; Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK
| | - Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
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Savva C, Mougiaris P, Xadjimichael C, Karagiannis C, Efstathiou M. Test-Retest Reliability of Handgrip Strength as an Outcome Measure in Patients With Symptoms of Shoulder Impingement Syndrome. J Manipulative Physiol Ther 2019; 41:252-257. [PMID: 29549892 DOI: 10.1016/j.jmpt.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 07/30/2017] [Accepted: 09/08/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the degree of test-retest reliability of grip strength measurement using a hand dynamometer in patients with shoulder impingement syndrome. METHODS A total of 19 patients (10 women and 9 men; mean ± standard deviation age, 33.2 ± 12.9 years; range 18-59 years) with shoulder impingement syndrome were measured using a hand dynamometer by the same data collector in 2 different testing sessions with a 7-day interval. During each session, patients were encouraged to exert 3 maximal isometric contractions on the affected hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC2,1) as well as the standard error of measurement (SEM) and Bland-Altman plot were used to estimate the degree of test-retest reliability and the measurement error, respectively. RESULTS Grip strength data analysis revealed an ICC2,1 score of 0.94, which, based on the Shrout classification, is considered as excellent test-retest reliability of grip strength measurement. The small values of SEMs reported in both sessions (SEM1, 2.55 Kgf; SEM2, 2.39 Kgf) and the small width of the 95% limits of agreement in the Bland-Altman plot (ranging from -7.39 Kgf to 7.03 Kgf) reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. CONCLUSIONS Results from this study identified excellent test-retest reliability of grip strength measurement in shoulder impingement syndrome, indicating its potential use as an outcome measure in clinical practice.
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Affiliation(s)
- Christos Savva
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Paraskevas Mougiaris
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | | | - Christos Karagiannis
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Michalis Efstathiou
- Department of Life and Health Science, 46 Makedonitissas Avenue, Engomi, University of Nicosia, Cyprus
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Walker T, Salt E, Lynch G, Littlewood C. Screening of the cervical spine in subacromial shoulder pain: A systematic review. Shoulder Elbow 2019; 11:305-315. [PMID: 31316592 PMCID: PMC6620799 DOI: 10.1177/1758573218798023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/09/2018] [Accepted: 07/07/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain. Currently, there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain, which risks patients receiving misguided and/or ineffective interventions. OBJECTIVE To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain. DESIGN Systematic review of randomized controlled trials. METHODS Electronic searches of PEDro and MEDLINE to December 2016 were conducted. Randomized controlled trials evaluating the effectiveness of interventions within the current scope of physiotherapy comprising of adult patients complaining of subacromial shoulder pain were included. Data relating to the method of cervical spine screening were extracted and synthesized categorically. RESULTS One hundred and two studies were included. Twenty-six (25.5%) were categorized as "No method of screening undertaken or reported," 49 (48.0%) were categorized as "Localized cervical spine symptoms and/or radiculopathy/radicular pain," nine (8.8%) were categorized as "Cervical examination," two (2.0%) were categorized as "Manual testing," two (2.0%) were categorized as "History of cervical surgery," and 14 (13.7%) were categorized as using "Combined approaches." CONCLUSION Examination of the cervical spine in patients with subacromial shoulder pain is variable in randomized controlled trials. In many instances, no or minimal attempts to screen were undertaken or reported. This has potential research and management implications and further research is indicated to facilitate development of this aspect of examination.
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Affiliation(s)
- Tom Walker
- Connect Health, Musculoskeletal Service, Dewsbury Health Centre, Dewsbury, UK,Tom Walker, Connect Health, Musculoskeletal Service, Dewsbury Health Centre, Wellington Road, Dewsbury WF13 1HN, UK.
| | - Emma Salt
- Burton Hospitals NHS Foundation Trust, Queen’s Hospital, Burton-on-Trent, UK
| | - Greg Lynch
- Inform Physiotherapy Limited, Silverstream, New Zealand
| | - Chris Littlewood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, UK
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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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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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A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series. J Orthop Sports Phys Ther 2019; 49:192-201. [PMID: 30658049 DOI: 10.2519/jospt.2019.8194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. This case series describes both short- and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. CASE DESCRIPTION Eleven patients with primary FSCS were treated with an individually tailored, multimodal manual therapy approach once weekly for 12 visits, coupled with home stretching exercises once a day, 5 days per week. Pain, disability, range of motion (ROM), and muscle strength of the affected shoulder were assessed at baseline, posttreatment, at 6 months, and at 9 months. OUTCOMES Significant improvements in self-reported pain, disability, shoulder ROM, and strength were reported following treatment. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference (MCID) on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. Moreover, 7 of 11 patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID postintervention and at 6 months, and 8 of 11 exceeded the MCID at 9 months. DISCUSSION Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in 11 patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, accounting for tissue irritability. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2019;49(3):192-201. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8194.
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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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41
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Land H, Gordon S, Watt K. Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1768. [DOI: 10.1002/pri.1768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/23/2018] [Accepted: 12/11/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Helen Land
- College of Healthcare SciencesJames Cook University Townsville Queensland Australia
| | - Susan Gordon
- School of Health SciencesFlinders University Bedford Park South Australia Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Vet SciencesJames Cook University Townsville Queensland Australia
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The management of shoulder impingement and related disorders: A systematic review on diagnostic accuracy of physical tests and manual therapy efficacy. J Bodyw Mov Ther 2018; 23:604-618. [PMID: 31563378 DOI: 10.1016/j.jbmt.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 06/25/2018] [Accepted: 08/25/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated. OBJECTIVES To investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions. METHODS A systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken. RESULTS 6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups. CONCLUSIONS Musculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment.
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Balasundaram AP, Sreerama Rajan S. Short-term effects of mobilisation with movement in patients with post-traumatic stiffness of the knee joint. J Bodyw Mov Ther 2018; 22:498-501. [PMID: 29861257 DOI: 10.1016/j.jbmt.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mobilisation with movement treatment techniques have been used to increase the range of motion following pathologies associated with shoulder, elbow and ankle joints. Lack of posterior tibial glide and reflex muscle inhibition are common physical impairments in individuals with post-traumatic stiffness of the knee joint. Current evidence is lacking for the benefits of mobilisation with movement treatment techniques for the knee joint disorders. OBJECTIVE The purpose of this study was to investigate the short-term effects of mobilisation with movement techniques following post-traumatic stiffness of the knee joint. METHODS Twenty consecutive patients with post-traumatic stiffness of the knee joint with a minimum available 80° knee flexion range of motion were included. One group pre-to-post-test study design was employed, in which the active knee flexion range of motion was used as an outcome measure. The mobilisation with movement treatment techniques was implemented with three sets of ten repetitions on each treatment occasion for a period of 3 days. RESULTS The mobilisation with movement treatment techniques significantly improved the active knee flexion range of motion (p = 0.000) from pre-treatment to post-treatment. CONCLUSIONS The findings from this study demonstrated immediate benefits in outcomes following mobilisation with movement treatment techniques in a cohort of patients with post-traumatic stiffness of the knee joint.
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Affiliation(s)
- Arun Prasad Balasundaram
- Department of Health Sciences, Harald Schjelderups Hus, Forskningsveien 3A, University of Oslo, 0317, Norway; Padmashree Institute of Physiotherapy, No.149, Padmashree Campus, Kommaghatta, Kengeri, Bangalore 560060, Karnataka, India.
| | - Sreedevi Sreerama Rajan
- Department of Physiotherapy, King Hamad University Hospital, Building 2345, Road 2835, Block 228, P.O. Box 24343, Bahrain; Padmashree Institute of Physiotherapy, No.149, Padmashree Campus, Kommaghatta, Kengeri, Bangalore 560060, Karnataka, India
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Minkalis AL, Vining RD, Long CR, Hawk C, de Luca K. A systematic review of thrust manipulation combined with one conservative intervention for rotator cuff and related non-surgical shoulder conditions. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2018; 62:5-17. [PMID: 30270924 PMCID: PMC6160900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine effects of thrust manipulation plus one conservative intervention for non-surgical shoulder pain and disability due to rotator cuff dysfunction. METHODS This review followed PRISMA guidelines. The databases searched were PubMed, PEDro, ICL, CINAHL, and AMED. Included were randomized trials with at least one group assigned to receive thrust manipulation and one adjunct conservative therapy. The PEDro scale was used to assess methodological quality and GRADE for analysis. RESULTS The search yielded 2088 articles with one meeting eligibility criteria. The trial examined thrust manipulation with exercise compared to sham. Statistically significant improvements in pain and disability were reported within but not between groups. Evidence quality according to the PEDro scale was good; GRADE was moderate. CONCLUSION Few trials have been conducted studying thrust manipulation plus another conservative intervention for rotator cuff conditions rendering available evidence of thrust manipulation plus exercise insufficient to determine effects of this combined treatment.
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Tejera-Falcón E, Toledo-Martel NDC, Sosa-Medina FM, Santana-González F, Quintana-de la Fe MDP, Gallego-Izquierdo T, Pecos-Martín D. Dry needling in a manual physiotherapy and therapeutic exercise protocol for patients with chronic mechanical shoulder pain of unspecific origin: a protocol for a randomized control trial. BMC Musculoskelet Disord 2017; 18:400. [PMID: 28923050 PMCID: PMC5604494 DOI: 10.1186/s12891-017-1746-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 08/29/2017] [Indexed: 01/06/2023] Open
Abstract
Background Shoulder pain of musculoskeletal origin is the main cause of upper limb pain of non-traumatic origin. Despite being one of the most common reasons for consultation, there is no established protocol for treatment due to the complexity of its etiology. However, it has been shown that the presence of myofascial trigger points on the shoulder muscles is a common condition associated with patients suffering from shoulder pain. This protocol has been created which describes the design of a randomized controlled trial to evaluate the effectiveness of the inclusion of dry needling (DN) within a protocol of manual physiotherapy and therapeutic exercise in the treatment of chronic shoulder pain of unspecific origin. Methods Thirty-six participants aged 18–65 years will be recruited having mechanical chronic shoulder pain on unspecific origin and meeting the inclusion criteria. These will be randomized to one of two interventions, (i) DN, manual physiotherapy and therapeutic exercise or (ii) sham DN, manual physiotherapy and therapeutic exercise. The protocol will cover 6 weeks of treatment, with a 6-month follow-up. Our main outcome measure will be the Visual Analogue Scale for pain. Discussion This is the first study to combine the use of DN, manual physiotherapy and an exercise program with a 6-month follow-up, thus becoming a new contribution to the treatment of chronic shoulder pain, while new lines of research may be established to help determine the effects of DN on chronic shoulder pain and the frequency and proper dosage. Trial registrations International Standard Randomized Controlled Trial Number Register: ISRCTN30604244 (http://www.controlled-trials.com) 29 June 2016.
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Affiliation(s)
| | | | | | | | | | - Tomás Gallego-Izquierdo
- Department of Physical Therapy and Pain Group, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Daniel Pecos-Martín
- Department of Physical Therapy and Pain Group, Universidad de Alcalá, Alcalá de Henares, Spain. .,Facultad de Enfermería y Fisioterapia, Universidad de Alcalá (Spain), Campus Científico-Tecnológico: CRTA. Madrid - Barcelona, km.33,600, Alcalá de Henares, Spain.
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The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report. Explore (NY) 2017; 13:339-343. [DOI: 10.1016/j.explore.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/20/2017] [Indexed: 11/20/2022]
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47
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A Review of Systematic Reviews of the Effectiveness of Conservative Interventions for Rotator Cuff Tendinopathy. Shoulder Elbow 2017. [DOI: 10.1111/sae.12009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Rotator cuff tendinopathy is common and a wide range of conservative interventions are currently used to treat this problem. The purpose of this review is to systematically review the systematic reviews that evaluate the effectiveness of conservative interventions for rotator cuff tendinopathy. Methods An electronic search of PEDro, MEDLINE and the Cochrane Library was undertaken and supplemented by hand and citation searching. The AMSTAR checklist was adopted for quality appraisal and a narrative synthesis was undertaken. Results Twenty-six systematic reviews were retrieved. Methodological quality was variable. Exercise and multimodal physiotherapy appear to confer superior outcomes over no treatment or placebo, although the clinical significance of these results remains unclear. Surgery does not confer an additional benefit over exercise alone or multimodal physiotherapy. Combining manual therapy with exercise is not currently supported, neither is the use of corticosteroid injections or acupuncture. Other commonly prescribed interventions lack evidence of effectiveness. Conclusions Exercise and multimodal physiotherapy might be effective interventions for rotator cuff tendinopathy, although the clinical significance of this effect is unclear. This interpretation is drawn from systematic reviews comprising mainly small randomized controlled trials that frequently measure outcome in a heterogeneous manner, limiting the strength of any conclusions.
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Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2017; 47:11-20. [PMID: 27937046 DOI: 10.2519/jospt.2017.6698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Multicenter, parallel randomized clinical trial. Background Myofascial trigger points (MTrPs) are implicated in shoulder pain and functional limitations. An intervention intended to treat MTrPs is dry needling. Objectives To investigate the effectiveness of dry needling in addition to evidence-based personalized physical therapy treatment in the treatment of shoulder pain. Methods One hundred twenty patients with nonspecific shoulder pain were randomly allocated into 2 parallel groups: (1) personalized, evidencebased physical therapy treatment; and (2) trigger point dry needling in addition to personalized, evidence-based physical therapy treatment. Patients were assessed at baseline, posttreatment, and 3-month follow-up. The primary outcome measure was pain assessed by a visual analog scale at 3 months, and secondary variables were joint range-of-motion limitations, Constant-Murley score for pain and function, and number of active MTrPs. Clinical efficacy was assessed using intention-to-treat analysis. Results Of the 120 enrolled patients, 63 were randomly assigned to the control group and 57 to the intervention group. There were no significant differences in outcome between the 2 treatment groups. Both groups showed improvement over time. Conclusion Dry needling did not offer benefits in addition to personalized, evidencebased physical therapy treatment for patients with nonspecific shoulder pain. Level of Evidence Therapy, level 1b. Registered February 11, 2009 at www.isrctn.com (ISRCTN30907460). J Orthop Sports Phys Ther 2017;47(1):11-20. Epub 9 Dec 2016. doi:10.2519/jospt.2017.6698.
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Oh JS, Kang MH, Dvir Z. Reproducibility of isometric shoulder protraction and retraction strength measurements in normal subjects and individuals with winged scapula. J Shoulder Elbow Surg 2016; 25:1816-1823. [PMID: 27262411 DOI: 10.1016/j.jse.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/25/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The strength of the shoulder protractors and retractors may be compromised in individuals with winged scapula (IwWS). However, no standard approach to measuring the strength of these muscles has been described. The aim of this study was to study the intra-rater and inter-rater reproducibility of a fixed-base isometric dynamometer and to describe cutoff scores for clinically meaningful change for protraction and retraction isometric strength. METHOD Twice during a week, 20 normal subjects and 20 IwWS were tested by 2 independent raters. RESULTS IwWS were significantly weaker (P < .001) than control subjects in their protraction and retraction isometric strength. Excellent intra-rater and inter-rater correlations were obtained in most combinations, leading to low cutoff scores for meaningful change expressed in terms of the smallest real difference. CONCLUSION When it is properly used, the technique described in this paper is recommended as an effective clinical tool for the quantitative assessment of protraction and retraction isometric strength, both for status determination and for monitoring of change in IwWS during and after rehabilitation.
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Affiliation(s)
- Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea
| | - Min-Hyeok Kang
- Department of Physical Therapy, Graduate School, Inje University, Gimhae, Republic of Korea
| | - Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Hazle CR, Lee M. Strategies to overcome size and mechanical disadvantages in manual therapy. J Man Manip Ther 2016; 24:120-7. [PMID: 27559282 DOI: 10.1080/10669817.2015.1119371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The practice of manual therapy (MT) is often difficult when providing care for large patients and for practitioners small in stature or with other physical limitations. Many MT techniques can be modified using simple principles to require less exertion, permitting consistency with standards of practice even in the presence of physical challenges. Commonly used MT techniques are herein described and demonstrated with alternative preparatory and movement methods, which can also be adopted for use in other techniques. These alternative techniques and the procedures used to adapt them warrant discussion among practitioners and educators in order to implement care, consistent with the best treatment evidence for many common musculoskeletal (MSK) conditions. The inclusion in educational curricula and MT training programs is recommended to enrich skill development in physical therapists (PTs), spanning entry-level practitioners to those pursuing advanced manual skills.
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Affiliation(s)
- Charles R Hazle
- Division of Physical Therapy, University of Kentucky, Lexington & Hazard, KY, USA
| | - Matthew Lee
- KORT-Nicholasville, Kentucky Orthopedic Rehab Team, Nicholasville, KY, USA
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