The effects of
scapular mobilization in patients with subacromial impingement syndrome:
Randomized, double-blind, placebo-clinical trial

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.

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.
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
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?

by: Jane McDevitt, PhD
by: Jeff Driban


Aytar A, Baltaci G, Uhl T, Tuzun H, Oztop P, & Karatas M (2014). The Effects of Scapular Mobilization in Patients With Subacromial Impingement Syndrome: Randomized, Double-Blind, Placebo-Clinical Trial. Journal of Sport Rehabilitation PMID: 25054347