The effects of scapular mobilization in patients with subacromial impingement syndrome: Randomized, double-blind, placebo-clinical trial
Aytar A., Baltaci G., Uhl T., Tuzun H., Oztop P., Karatas M. Journal of Sport Rehabilitation. 2014; ahead of print
Take Home Message: Scapular mobilizations, sham mobilizations, and supervised exercise can help alleviate symptoms related to subacromial impingement syndrome but no intervention was most effective.
Subacromial impingement syndrome accounts for 44 to 66% of all shoulder pain complaints. Clinicians may use many types of manual therapy interventions to regain motion and improve function (for example, scapular mobilization); however, there is limited evidence to support the benefits and effectiveness of scapular mobilization. Therefore, the authors conducted a randomized clinical trial to determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction among patients with subacromial impingement syndrome. Sixty-six patients (51 females; on average 52 years of age) participated in this 3-week (9 treatment) study, and were followed an additional 8 weeks after their last treatment. The authors randomized patients into 1 of 3 groups: scapular mobilization, sham scapular mobilization, or supervised exercise. To ensure proper blinding one physical therapist performed all of the evaluations and a second physical therapist performed all of the treatments. The main outcome measures were the Quick Disability of Arm and Should Hand Questionnaire and pain on a visual analog scale at baseline, the 5th visit, 10th visit, 4 weeks after the 9th visit, and 8 weeks after the 9th visit. The evaluator also assessed range of motion and participant satisfaction was measured using a 7-point Likert scale. Patients were educated on ways to decrease pain during daily activities. Also, before each therapy session all patients received transcutaneous electrical stimulation with a hot pack. Scapular mobilization was performed side-lying with the application of superior and inferior gliding, rotations, and distraction to the scapula of the affected shoulder with the hand placement at the superior and inferior angle of the scapula. The procedures for the sham scapular mobilization were the same except the borders of the scapula were not grasped, instead hands were placed randomly along the scapula, and the skin was moved with minimal pressure so there were no mobilizations. The supervised exercise group performed stretching and strengthening exercises. The three groups had similar shoulder function, pain, and range of motion at baseline. Following therapy there were no differences between groups with their pain scores, Disability of Arm and Should Hand Questionnaire scores, range of motion, or patient satisfaction scores. However, all the patients demonstrated increases in shoulder motion, function as well as decrease in pain following therapy, which plateaued after therapy.
This study revealed that scapular mobilization, sham mobilizations, and supervised exercise can help alleviate symptoms related to subacromial impingement syndrome but no intervention was most effective. It was interesting to note that even the sham group improved functionally and had good patient satisfaction, which suggests that patient education, transcutaneous electrical stimulation with a hot pack, and one-on-one interactions could be factors contributing to this group’s better outcome. It would be interesting to know how long the patients had their symptoms prior to starting the study as well as whether they had previously tried rehabilitation because this could influence who clinicians may try to apply these results to in their practice. Medical professionals should note that patient education as well as well as some sort of one-on-one interaction, whether it be verbal or manual therapy, may be a beneficial component of a rehabilitation program for those suffering from subacromial impingement syndrome.
Questions for Discussion: Do you think scapular mobilization along with stretching and strengthening exercises would be more beneficial than a single therapeutic rehabilitation intervention? What therapy do you use for subacromial impingement syndrome? Do you educate your patients before as well as throughout therapy on how to decrease pain and increase shoulder function?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban
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