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

Purpose of this current research was to find out the effectiveness of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome in order to improve pain, functional capacity and scapular range of motion.

Parallel Single Blinded Randomized Controlled Trial

The Eligible patients for Exercises and Manual Therapy referring to The University of Lahore Teaching Hospital city Lahore during the study period was enrolled in the trial and was randomly allocated to the intervention and control group through block randomization. The trial was single blinded so that physician was not aware of the intervention.

Inclusion: Shoulder Impingement Syndrome from more than 3 months History of non-traumatic onset of shoulder pain, positive painful arc during active elevation of arm. positive (Hawkins-Kennedy, Neer’s test). Exclusion: Fracture( clavicle, humerus, Scapula) Systemic Illness numbness or tingling of the upper limb a positive sulcus or apprehension test, positive drop arm test

Group A was treated with exercises and 45 minutes of manual therapy with rest interval of 1 min . The grade lll and lV mobilization were performed including arthrokinematic movements for different sub-joints at the shoulder: Group B was given only strengthening and stretching exercises for both involved and uninvolved sides and session longed for 25-30 minutes. For both Group A and B The participants were assessed pre-intervention and post-intervention(after 4 week).No Of sessions were 3 per week for 4 weeks.Total duration of intervention was 1 month.

Disability of arm, Shoulder and Hand Questionnaire: Functional Capacity. Numeric Pain Rating Scale :pain. Goniometry :scapular ranges

In this study, a total of 36 participants were enrolled, and they were assigned to two treatment groups using computer-generated randomization. Simple randomization process was performed using Microsoft Excel which is a computer-based random number generator . Each participant received a unique identifier, and a sequence of 36 random numbers was generated by the computer. These random numbers were then used to allocate participants to either Group A or Group B.Group A consisted of participants who received manual therapy along with stretching and strengthening exercises. On the other hand, Group B included participants who received only the stretching and strengthening exercises without manual therapy. Unit of randomization was individual.The utilization of computer-generated randomization ensured that the assignment of participants to treatment groups was unbiased and fair. To further eliminate biasness, researchers also employed the concealed envelope method. For each participant, a sealed envelope was prepared, containing the information about which group (Group A or Group B) the participant would be assigned to.

This was a single blinded study in which It is difficult to blind patients and therapists so only the assessor who was also a health care provider was kept blinded due to treatment regime. It is believed that while measuring effectiveness of an intervention, it is difficult to blind patients and therapists, so, outcome assessor blinding is done.