Effects of Muscle Energy Technique versus Shoulder Mobilization on Pain and Function in Patients with Subacromial Pain Syndrome

Abstract

Background Subacromial pain syndrome is most leading cause of disability that includes the wide spectrum of disorders including subacromial tendinopathy, partial or full thickness tear of rotator cuff and subacromial bursitis. The manual therapy interventions for this condition are still debatable.

Aim To evaluate the comparative effects of muscle energy technique (MET) versus posterior shoulder mobilization with movement (MWM) on pain, function and shoulder range of motion in patients with subacromial pain syndrome.

Method Patients diagnosed with subacromial pain syndrome were recruited in this pragmatic parallel double blinded randomized clinical trial. The sample was selected through non-probability convenient sampling technique. Forty patients out of 56 meeting the eligibility criteria were equally divided into two groups, MET group (n = 20) and MWM group (n = 20), through a randomization web service. Data were collected at baseline and after successful completion of a six week trial treatment. Pain severity was measured by using a numeric pain rating scale, shoulder disability was measured by using the Shoulder Pain and Disability Index (SPADI) and ranges of motion were measured by using goniometry. Data was analyzed through SPSS 24.

Results Outcome measures including pain, disability and shoulder range of motion were significantly (p ≤ 0.05) improved in both groups after the intervention. When comparing both groups, pain score was U = 82.0 (p ≤ 0.001) and disability score was t = –2.913 (p ≤ 0.006) favoring MET.

Conclusion Both MET and MWM were effective for symptomatic management in this sample of 40 patients with subacromial impingement syndrome. MET seems to show some superior effects as compared to MWM.

Zusammenfassung

Hintergrund Das subakromiale Schmerzsyndrom ist die häufigste Ursache für Behinderungen und umfasst ein breites Spektrum an Erkrankungen, darunter subakromiale Tendinopathie, teilweiser oder vollständiger Riss der Rotatorenmanschette und subakromiale Schleimbeutelentzündung. Die manuellen Therapieinterventionen für diese Erkrankung sind immer noch umstritten.

Ziel Untersuchung und Bewertung der Auswirkungen der Muskelenergietechnik (MET) im Vergleich zur hinteren Schultermobilisierung mit Bewegung (MWM) auf Schmerzen, Funktion und den Bewegungsradius der Schulter bei Patient*innen mit subakromialem Schmerzsyndrom.

Methode Für die pragmatische, parallele, doppelt verblindete, randomisierte klinische Studie wurden Patient*innen mit diagnostiziertem subakromialem Schmerzsyndrom rekrutiert. Die Stichprobe wurde mithilfe eines Nicht-Wahrscheinlichkeits-Stichprobenverfahrens ausgewählt. 40 der 56 Patient*innen, die die Zulassungskriterien erfüllten, wurden über einen Randomisierungs-Webdienst zu gleichen Teilen in 2 Gruppen aufgeteilt: die MET-Gruppe (n = 20) und die MWM-Gruppe (n = 20). Die Daten wurden zu Studienbeginn und nach erfolgreichem Abschluss einer 6-wöchigen Probebehandlung erhoben. Die Schmerzintensität wurde mithilfe einer numerischen Schmerzbewertungsskala gemessen, die Schulterbehinderung mithilfe des Shoulder Pain and Disability Index (SPADI) und der Bewegungsumfang mithilfe der Goniometrie gemessen. Die Daten wurden mit SPSS 24 analysiert.

Ergebnisse Ergebnisparameter wie Schmerzen, Behinderung und Schulterbewegungsumfang verbesserten sich in beiden Gruppen nach der Intervention signifikant (p ≤ 0,05). Beim Vergleich beider Gruppen betrug der Schmerzscore U = 82,0 (p ≤ 0,001) und der Behinderungsscore t = –2,913 (p ≤ 0,006) zugunsten von MET.

Schlussfolgerung Sowohl MET als auch MWM waren zur symptomatischen Behandlung der Stichprobe von 40 Patient*innen mit subakromialem Schmerzsyndrom wirksam. MET scheint im Vergleich zu MWM eine überlegene Wirkung zu zeigen.

Key words

muscle energy technique - mulligan mobilization - shoulder disability - shoulder mobilization - shoulder pain syndrome

Schlüsselwörter

Muskelenergietechnik - Mulligan-Mobilisierung - Schulterbehinderung - Schultermobilisierung - Schulterschmerzsyndrom

Publication History

Received: 25 March 2023

Accepted: 06 June 2023

Article published online:
26 July 2023

• References

• 1 Steuri R. et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Brit J Sports Med 2017; 51: 1340-1347
• 2 Tekeoglu I. et al. The relationship between shoulder impingement syndrome and sleep quality. Eur Rev Med Pharmacol Sci 2013; 17: 370-374
• 3 Su X. et al. Effects of high- and low-energy radial shock waves therapy combined with physiotherapy in the treatment of rotator cuff tendinopathy: a retrospective study. Disabil Rehabil 2018; 40: 2488-2494
• 4 Lui PPY. Tendinopathy in diabetes mellitus patients-Epidemiology, pathogenesis, and management. Scand J Med Sci Sports 2017; 27: 776-787
• 5 Millar NL. et al. Tendinopathy. Nat Rev Dis Primers 2021; 7: 1
• 6 Dakin SG. et al. Chronic inflammation is a feature of Achilles tendinopathy and rupture. Br J Sports Med 2018; 52: 359-367
• 7 Minagawa H. et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop 2013; 10: 8-12
• 8 Chianca V. et al. Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed 2018; 89: 186-196
• 9 Ager AL. et al. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med 2019; 184: e385-e393
• 10 Balke M. et al. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 2013; 84: 178-183
• 11 Kenmoku T. et al. Comparison of glenohumeral joint rotation between asymptomatic subjects and patients with subacromial impingement syndrome using cine-magnetic resonance imaging: a cross-sectional study. BMC Musculoskelet Disord 2019; 20: 475
• 12 Louwerens JK. et al. Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg 2015; 24: 1588-1593
• 13 Sansone V. et al. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiol 2016; 45: 49-55
• 14 Chang KV. et al. Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections. Arch Phys Med Rehabil 2017; 98: 1984-1994
• 15 Sansone V. et al. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiology 2016; 45: 49-55
• 16 Bennett S, Macfarlane C, Vaughan B. The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report. Explore (NY) 2017; 13: 339-343
• 17 Gebremariam L. et al. Subacromial impingement syndrome – effectiveness of physiotherapy and manual therapy. Br J Sports Med 2014; 48: 1202-1208
• 18 Singh H, Thind A, Mohamed NS. Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies. Cureus 2022; 14: e28405
• 19 Grant S. et al. CONSORT-SPI 2018 Explanation and Elaboration: guidance for reporting social and psychological intervention trials. Trials 2018; 19: 406
• 20 Haider R. et al. Comparison of conservative exercise therapy with and without Maitland Thoracic Manipulative therapy in patients with subacromial pain: Clinical trial. J Pak Med Assoc 2018; 68: 381-387
• 21 Garving C. et al. Impingement Syndrome of the Shoulder. Deutsches Arzteblatt international 2017; 114: 765-776
• 22 Gismervik SØ. et al. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskel Dis 2017; 18: 41
• 23 Park SJ, Kim SH, Kim SH. Effects of Thoracic Mobilization and Extension Exercise on Thoracic Alignment and Shoulder Function in Patients with Subacromial Impingement Syndrome: A Randomized Controlled Pilot Study. Healthcare (Basel) 2020; 8: 316
• 24 Mangnus TJP. et al. Intermittent versus continuous esketamine infusions for long-term pain modulation in complex regional pain syndrome: protocol of a randomized controlled non-inferiority study (KetCRPS-2). BMC Musculoskel Dis 2023; 24: 239
• 25 Kraal T. et al. Manipulation under anesthesia versus physiotherapy treatment in stage two of a frozen shoulder: a study protocol for a randomized controlled trial. BMC Musculoskel Dis 2017; 18: 412
• 26 de Oliveira FCL. et al. Kinesiotaping for the Rehabilitation of Rotator Cuff-Related Shoulder Pain: A Randomized Clinical Trial. Sports Health 2021; 13: 161-172
• 27 Littlewood C. et al. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clin Rehabil 2016; 30: 686-696
• 28 Thomas A. et al. Effect of Muscle Energy Techniques V/S Active Range of Motion Exercises on Shoulder Function Post Modified Radical Neck Dissection in patients with Head and Neck Cancer – A Randomized Clinical Trial. Asian Pac J Cancer Prev 2020; 21: 2389-2393
• 29 Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulliganʼs 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
• 30 Kachewar SG, Kulkarni DS. Calcific tendinitis of the rotator cuff: a review. J Clin Diagn Res 2013; 7: 1482-1485
• 31 Phadke A. et al. Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: A randomized controlled trial. Hong Kong Physiother J 2016; 35: 5-11
• 32 Reed ML, Begalle RL, Laudner KG. Acute effects of muscle energy technique and joint mobilization on shoulder tightness in youth throwing athletes: a randomized controlled trial. Int J Sports Phys Ther 2018; 13: 1024-1031
• 33 Faqih AI. et al. Effects of muscle energy technique on pain, range of motion and function in patients with post-surgical elbow stiffness: a randomized controlled trial. Hong Kong Physiother J 2019; 39: 25-33
• 34 Kumar GY, Sneha P, Sivajyothi N. Effectiveness of Muscle energy technique, Ischaemic compression and Strain counterstrain on Upper Trapezius Trigger Points: A comparative study. Int J Phys Edu, Sports and Health 2015; 1: 22-26
• 35 Shady MA. et al. Comparative study between the effect of passive stretching exercises and post isometric relaxation technique in chronic mechanical neck pain patients. Euro J Molecular & Clin Med 2021; 8: 2271-2278
• 36 Bose G, Dusad G. Effect of reciprocal inhibition and post isometric relaxation; types of muscle energy technique in piriformis syndrome – a comparative study. EJPMR 2018; 5: 558-563
• 37 Duzgun I. et al. Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?. J Musculoskel Neuronal Interact 2019; 19: 311-316
• 38 Rosa DP. et al. Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial. Braz J Phys Ther 2021; 25: 648-658
• 39 Medina-Gandionco M, Briggs RA. Calcific Tendinopathy of the Rotator Cuff Treated with Acetic Acid Iontophoresis. J Orthop Sports Phys Ther 2020; 50: 650
• 40 Holdaway LA. et al. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskel Dis 2018; 19: 408-408