Effectiveness of Manual Therapy and Specific Exercise Conditioning on Clinical Outcome Measures among Participants with Subacromial Impingement Syndrome

Abstract

Shoulder subacromial impingement syndrome (SIS) is a mechanical disturbance caused by a multifactorial aetiology, and conservative treatment is the first choice. This study aims to investigate the combined short-term effect of manual therapy and eccentric exercise conditioning on clinical outcomes in the acute phase. We recruited 126 subjects with a SIS of 3 months' duration and divided them into two groups of 63 people each. The experimental group received manual therapy and eccentric exercise; the control group received concentric exercise, spread over 3 weeks, followed by a home program for another 9 weeks. Pain intensity, shoulder elevation range, abductor and external rotator muscle strength, and regional function were obtained at baseline, after 10 sessions of treatment and follow-up at 12 weeks. After the first session and by the end of 3 weeks, a global rating of change (GRC) questionnaire was administered to determine self-perceived improvement. An analysis of variance with repeated measures was applied, and the results showed that there were statistically significant differences in both groups; all outcomes improved after treatment and during follow-up (<i>P</i> < 0.005). However, on intergroup analysis, significant improvement was observed with pain intensity (<i>P</i> < 0.0005), elevation range of motion (<i>P</i> < 0.05) and external rotator muscle strength (<i>P</i> < 0.016) after treatment, and external rotator muscle strength and SPADI score (<i>P</i> < 0.0005) at follow-up by 12 weeks in the experimental group. The between-group comparison revealed that pain reduction by 3 weeks, external rotator muscle strength by 3 and 12 weeks, had resulted in a large effect size. Manual therapy and eccentric exercise can reduce pain intensity, improve shoulder elevation range, and gleno-humeral muscle strength after 12 weeks of training better than concentric exercises. The improvement in shoulder function with the experimental group exceeded the MCID of 13 points, resulting in a large and significant effect size (d = 1.08). The self-perceived improvement (GRC) was significant in the experimental group (<i>P</i> < 0.001) with a clinically significant change greater than the MCID (3 points).