A RANDOMIZED CLINICAL TRIAL ON THE ROLE OF THORACIC SPINE MANIPULATION AND SCAPULAR STABILIZATION IN SUBACROMIAL SHOULDER IMPINGEMENT SYNDROME

Authors

  • Manas Kumar Research Scholar, School of Pharmacy & Sciences, Singhania University, Jhunjhunu Rajasthan
  • Dr. Annu Jain Assistant Professor, MPT, PhD., Singhania University

DOI:

https://doi.org/10.29121/shodhkosh.v5.i6.2024.4581

Keywords:

Shoulder Impingement, Thoracic Manipulation, Scapular Stabilization, Physical Therapy, Randomized Controlled Trial

Abstract [English]

Subacromial shoulder impingement syndrome (SSIS) is a common cause of shoulder pain that significantly impacts functional ability and quality of life. This randomized clinical trial examined the effectiveness of thoracic spine manipulation (TSM) combined with scapular stabilization exercises (SSE) compared to standard physical therapy for patients with SSIS. One hundred and twenty participants with diagnosed SSIS were randomly assigned to either an experimental group (TSM+SSE) or a control group (standard care). Outcomes were measured using the Shoulder Pain and Disability Index (SPADI), pain visual analog scale (VAS), range of motion (ROM), and patient-reported functional outcomes at baseline, 4 weeks, and 8 weeks. Results demonstrated that the TSM+SSE group showed significantly greater improvements in pain reduction (mean difference 2.1 points on VAS, p<0.001), shoulder function (mean difference 14.3 points on SPADI, p<0.001), and ROM (mean increase of 23° in scapular upward rotation, p<0.001) compared to the control group at 8 weeks. These findings suggest that the integration of thoracic spine manipulation with targeted scapular stabilization exercises provides superior outcomes for SSIS management compared to standard care alone, supporting a regional interdependence approach to rehabilitation.

References

Bialosky, J. E., Beneciuk, J. M., Bishop, M. D., Coronado, R. A., Penza, C. W., Simon, C. B., & George, S. Z. (2018). Unraveling the mechanisms of manual therapy: Modeling an approach. Journal of Orthopaedic & Sports Physical Therapy, 48(1), 8-18. DOI: https://doi.org/10.2519/jospt.2018.7476

Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2015). Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: A multi-center randomized clinical trial. BMC Musculoskeletal Disorders, 16(1), 64. DOI: https://doi.org/10.1186/s12891-016-0912-3

Haik, M. N., Alburquerque-Sendín, F., Moreira, R. F., Pires, E. D., & Camargo, P. R. (2014). Effectiveness of physical therapy treatment of clearly defined subacromial pain: A systematic review of randomised controlled trials. British Journal of Sports Medicine, 48(16), 1216-1226.

Heneghan, N. R., Lokhaug, S. M., Tyros, I., Longvastøl, S., & Rushton, A. (2018). Clinical reasoning framework for thoracic spine exercise prescription in sport: A systematic review and narrative synthesis. BMJ Open Sport & Exercise Medicine, 4(1), e000429. DOI: https://doi.org/10.1016/j.physio.2018.11.240

Kaya, D. O., Baltaci, G., Toprak, U., & Atay, A. O. (2014). The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: A preliminary trial. Journal of Manipulative and Physiological Therapeutics, 37(6), 422-432. DOI: https://doi.org/10.1016/j.jmpt.2014.03.004

Kibler, W. B., Ludewig, P. M., McClure, P. W., Michener, L. A., Bak, K., & Sciascia, A. D. (2013). Clinical implications of scapular dyskinesis in shoulder injury: The 2013 consensus statement from the 'Scapular Summit'. British Journal of Sports Medicine, 47(14), 877-885. DOI: https://doi.org/10.1136/bjsports-2013-092425

Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57-68. DOI: https://doi.org/10.1016/j.math.2016.03.009

Ludewig, P. M., & Cook, T. M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy, 80(3), 276-291. DOI: https://doi.org/10.1093/ptj/80.3.276

Ludewig, P. M., & Reynolds, J. F. (2009). The association of scapular kinematics and glenohumeral joint pathologies. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 90-104. DOI: https://doi.org/10.2519/jospt.2009.2808

Maitland, G., Hengeveld, E., Banks, K., & English, K. (2013). Maitland's vertebral manipulation (8th ed.). Churchill Livingstone.

Michener, L. A., Walsworth, M. K., Doukas, W. C., & Murphy, K. P. (2015). Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Archives of Physical Medicine and Rehabilitation, 96(3), 444-450.

Mintken, P. E., McDevitt, A. W., Cleland, J. A., Boyles, R. E., Beardslee, A. R., Burns, S. A., Haberl, M. D., Hinrichs, L. A., & Michener, L. A. (2016). Cervicothoracic manual therapy plus exercise therapy versus exercise therapy alone in the management of individuals with shoulder pain: A multicenter randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 617-628. DOI: https://doi.org/10.2519/jospt.2016.6319

Page, M. J., Green, S., McBain, B., Surace, S. J., Deitch, J., Lyttle, N., Mrocki, M. A., & Buchbinder, R. (2016). Manual therapy and exercise for rotator cuff disease. Cochrane Database of Systematic Reviews, (6), CD012224. DOI: https://doi.org/10.1002/14651858.CD012224

Peek, A. L., Miller, C., & Heneghan, N. R. (2015). Thoracic manual therapy in the management of non-specific shoulder pain: A systematic review. Journal of Manual & Manipulative Therapy, 23(4), 176-187. DOI: https://doi.org/10.1179/2042618615Y.0000000003

Struyf, F., Nijs, J., Mollekens, S., Jeurissen, I., Truijen, S., Mottram, S., & Meeusen, R. (2013). Scapular-focused treatment in patients with shoulder impingement syndrome: A randomized clinical trial. Clinical Rheumatology, 32(1), 73-85. DOI: https://doi.org/10.1007/s10067-012-2093-2

Theisen, C., van Wagensveld, A., Timmesfeld, N., Efe, T., Heyse, T. J., Fuchs-Winkelmann, S., & Schofer, M. D. (2010). Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine - a prospective study with ultrasound-based motion analysis. BMC Musculoskeletal Disorders, 11, 135. DOI: https://doi.org/10.1186/1471-2474-11-135

Wainner, R. S., Whitman, J. M., Cleland, J. A., & Flynn, T. W. (2007). Regional interdependence: A musculoskeletal examination model whose time has come. Journal of Orthopaedic & Sports Physical Therapy, 37(11), 658-660. DOI: https://doi.org/10.2519/jospt.2007.0110

Downloads

Published

2024-06-30

How to Cite

Kumar, M., & Jain, D. A. (2024). A RANDOMIZED CLINICAL TRIAL ON THE ROLE OF THORACIC SPINE MANIPULATION AND SCAPULAR STABILIZATION IN SUBACROMIAL SHOULDER IMPINGEMENT SYNDROME. ShodhKosh: Journal of Visual and Performing Arts, 5(6), 1159–1167. https://doi.org/10.29121/shodhkosh.v5.i6.2024.4581