Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Comparison of the Effects of Mulligan Mobilization with Movement Method and Conventional Rehabilitation Protocol on Shoulder Pain and Functions in Subacromial Pain Syndrome: A Prospective Randomized Single Blind Trial
Subakromiyal Ağrı Sendromunda Mulligan Hareketle Mobilizasyon Yöntemi ve Konvansiyonel Rehabilitasyon Protokolünün Omuz Ağrı ve Fonksiyonları Üzerine Olan Etkilerinin Karşılaştırılması: Prospektif Randomize Tek Kör Çalışma
Volkan DENİZa, Ali KIVRAKb, Bülent ELBASANa, Tunay SARPELb
aGazi University Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, TURKEY
bÇukurova University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Adana, TURKEY
Turkiye Klinikleri J Health Sci. 2021;6(1):78-87
doi: 10.5336/healthsci.2020-75110
Article Language: EN
Full Text
ABSTRACT
Objective: To determine and compare the periodic effects of conventional rehabilitation protocol (CRP) and Mulligan mobilization with movement (MWM) in subacromial pain syndrome (SAPS) patients. Material and Methods: This was a prospective randomized single-blind clinical trial. Fourty two patients with unilateral SAPS were randomized to two groups; CRP or MWM. Participants received CRP and MWM treatments for six weeks. Shoulder pain and function of the patients were evaluated with Shoulder Pain and Disability Index, Subacromial Interval Measurement, Goniometric Range of motion measurement and Visual Analogue Scale were assessed. Assessments at baseline, at the end of the first session, at the end of the second, fourth and sixth weeks were performed. Results: The two treatment groups showed significant improvements in pain and physical functions after six weeks (p0.05). Conclusion: MWM and CRP are effective in improving shoulder pain and functions in SAPS. Furthermore, while MWM is more effective in initial phase of rehabilitation than CRP, there is no difference between the two methods in other periods.

Keywords: Shoulder pain; musculoskeletal manipulations; exercise; shoulder impingement syndrome
ÖZET
Amaç: Subakromiyal ağrı sendromu (SAS) olan hastalarda Mulligan Hareketle Mobilizasyon Yöntemi (MHM) ve Konvansiyonel Rehabilitasyon Protokolü'nün (KRP) periyodik etkilerini belirlemek ve karşılaştırmaktı. Gereç ve Yöntemler: Çalışma prospektif randomize ve tek kör olarak yapıldı. Unilateral SAS tanısı alan 42 hasta KRP ve MWM gruplarına randomize edildi. Hastalara KRP ve MHM tedavi yöntemleri altı hafta boyunca uygulandı. Hastaların omuz ağrısı ve fonksiyonları; Omuz Ağrı ve Özürlülük İndeksi, Subakromiyal Aralık Ölçümü, Gonyometrik Eklem Hareket Açıklığı Ölçümü ve Görsel Analog Skala ile değerlendirildi. Değerlendirme; tedavi öncesinde, birinci seansın, ikinci, dördüncü ve altıncı haftanın sonunda yapıldı. Bulgular: Tedavi sonunda her iki grupta yer alan hastaların omuz ağrı ve fonksiyonlarında iyileşme görüldü (p0,05). Sonuç: SAS hastalarında, MWM ve KRP omuz ağrısının ve fonksiyonlarının iyileştirilmesinde kullanılabilecek etkili yöntemlerdir. Bununla birlikte tedavinin ilk döneminde MWM, KRP' ye göre daha etkiliyken diğer periyotlarda iki yöntem arasında fark yoktur.

Anahtar Kelimeler: Omuz ağrısı; kas-iskelet manipülasyonları; egzersiz; omuz sıkışma sendromu
REFERENCES:
  1. Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil. 2006;16(1):7-25.[Crossref] [PubMed] 
  2. Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Dutch Orthopaedic Association. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314-22.[Crossref] [PubMed] [PMC] 
  3. Kvalvaag E, Brox JI, Engebretsen KB, Soberg HL, Juel NG, Bautz-Holter E, et al. Effectiveness of Radial Extracorporeal Shock Wave Therapy (rESWT) When Combined With Supervised Exercises in Patients With Subacromial Shoulder Pain: A Double-Masked, Randomized, Sham-Controlled Trial. Am J Sports Med. 2017;45(11):2547-54.[Crossref] [PubMed] 
  4. Keshavarz R, Bashardoust Tajali S, Mir SM, Ashrafi H. The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach. J Bodyw Mov Ther. 2017;21(2):386-400.[Crossref] [PubMed] 
  5. Savoie A, Mercier C, Desmeules F, Frémont P, Roy JS. Effects of a movement training oriented rehabilitation program on symptoms, functional limitations and acromiohumeral distance in individuals with subacromial pain syndrome. Man Ther. 2015;20(5):703-8.[Crossref] [PubMed] 
  6. Bernhardt GA, Glehr M, Zacherl M, Wurnig C, Gruber G. Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs. Eur J Orthop Surg Traumatol. 2013;23(2):185-90.[Crossref] [PubMed] 
  7. Düzgün I, Baltacı G, Atay OA. Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair: pain and functional activity. Acta Orthop Traumatol Turc. 2011;45(1):23-33.[Crossref] [PubMed] 
  8. Thienpont E. Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty? Clin Orthop Relat Res. 2014;472(11):3417-23.[Crossref] [PubMed] [PMC] 
  9. Herbert RD, Gabriel M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ. 2002;325(7362):468.[Crossref] [PubMed] [PMC] 
  10. Mulligan B. Manual Therapy: NAGS, SNAGS, MWMS etc. 6th. Wellington, New Zealand: Plane View Services Ltd, 2010.
  11. Vicenzino B, Paungmali A, Teys P. Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther. 2007;12(2):98-108.[Crossref] [PubMed] 
  12. Teys P, Bisset L, Vicenzino B. The initial effects of a Mulligan's mobilization with movement technique on range of movement and pressure pain threshold in pain-limited shoulders. Man Ther. 2008;13(1):37-42.[Crossref] [PubMed] 
  13. Menek B, Tarakci D, Algun ZC. The effect of Mulligan mobilization on pain and life quality of patients with Rotator cuff syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil. 2019;32(1):171-8.[Crossref] [PubMed] 
  14. Hussein ZA. Efficacy of mobilization techniques and range of motion in patients with adhesive capsulitis of the shoulder pain . International Journal of Research in Pharmaceutical Sciences. 2019;10(1):313-7.[Link] 
  15. Gong W, Lee H, Lee Y. Effects of Gong's Mobilization applied to shoulder joint on shoulder abduction. J. Phy. Ther. Sci. 2011;23(3);391-3.[Crossref] 
  16. Hill CL, Lester S, Taylor AW, Shanahan ME, Gill TK. Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. BMC Musculoskelet Disord. 2011;12:8.[Crossref] [PubMed] [PMC] 
  17. Bumin G, Tuzun EH, Tonga E. The Shoulder Pain and Disability Index (SPADI): Cross-cultural adaptation, reliability, and validity of the Turkish version. Journal of Back and Musculoskeletal Rehabilitation. 2008;21(1):57-62.[Crossref] 
  18. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991;4(4):143-9.[Crossref] [PubMed] 
  19. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007-19.[Crossref] [PubMed] 
  20. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52.[Crossref] [PubMed] 
  21. Kolber MJ, Hanney WJ. The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: a technical report. Int J Sports Phys Ther. 2012;7(3):306-13.[PubMed] [PMC] 
  22. Lunden JB, Muffenbier M, Giveans MR, Cieminski CJ. Reliability of shoulder internal rotation passive range of motion measurements in the supine versus sidelying position. J Orthop Sports Phys Ther. 2010;40(9):589-94.[Crossref] [PubMed] 
  23. de Oliveira FCL, de Fontenay BP, Bouyer LJ, Desmeules F, Roy JS. Effects of kinesiotaping added to a rehabilitation programme for patients with rotator cuff tendinopathy: protocol for a single-blind, randomised controlled trial addressing symptoms, functional limitations and underlying deficits. BMJ Open. 2017;7(9):e017951.[Crossref] [PubMed] [PMC] 
  24. GOLDING FC. The shoulder--the forgotten joint. Br J Radiol. 1962;35:149-58.[Crossref] [PubMed] 
  25. Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C, et al. Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg. 2010;19(1):10-3.[Crossref] [PubMed] 
  26. Lehtinen JT, Belt EA, Lybäck CO, Kauppi MJ, Kaarela K, Kautiainen HJ, et al. Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders. J Shoulder Elbow Surg. 2000;9(3):183-7.[Crossref] [PubMed] 
  27. Granviken F, Vasseljen O. Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trial. J Physiother. 2015;61(3):135-41.[Crossref] [PubMed] 
  28. Hotta GH, Santos AL, McQuade KJ, de Oliveira AS. Scapular-focused exercise treatment protocol for shoulder impingement symptoms: Three-dimensional scapular kinematics analysis. Clin Biomech (Bristol, Avon). 2018;51:76-81.[Crossref] [PubMed] 
  29. Akkaya N, Akkaya S, Gungor HR, Yaşar G, Atalay NS, Sahin F, et al. Effects of weighted and un-weighted pendulum exercises on ultrasonographic acromiohumeral distance in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2017;30(2):221-8.[Crossref] [PubMed] 
  30. Boudreau N, Gaudreault N, Roy JS, Bédard S, Balg F. The Addition of Glenohumeral Adductor Coactivation to a Rotator Cuff Exercise Program for Rotator Cuff Tendinopathy: A Single-Blind Randomized Controlled Trial. J Orthop Sports Phys Ther. 2019;49(3):126-135.[Crossref] [PubMed] 
  31. Paungmali A, O'Leary S, Souvlis T, Vicenzino B. Hypoalgesic and sympathoexcitatory effects of mobilization with movement for lateral epicondylalgia. Phys Ther. 2003;83(4):374-83.[Crossref] [PubMed] 
  32. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18:927-32.[Crossref] [PubMed] 
  33. Chen JF, Ginn KA, Herbert RD. Passive mobilisation of shoulder region joints plus advice and exercise does not reduce pain and disability more than advice and exercise alone: a randomised trial. Aust J Physiother. 2009;55(1):17-23.[Crossref] [PubMed] 
  34. Gutiérrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C, Álvarez-Bueno C, Martínez-Vizcaíno V, Cavero-Redondo I, et al. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis. Phys Ther Sport. 2020;41:34-42.[Crossref] [PubMed] 
  35. Şenbursa G, Baltaci G, Atay ÖA. The effectiveness of manual therapy in supraspinatus tendinopathy. Acta Orthop Traumatol Turc. 2011;45(3):162-7.[Crossref] [PubMed] 
  36. Petrofsky JS, Laymon MS, Alshammari FS, Lee H. Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial. J Strength Cond Res. 2016;30(11):3107-15.[Crossref] [PubMed] 
  37. Satpute KH, Bhandari P, Hall T. Efficacy of Hand Behind Back Mobilization With Movement for Acute Shoulder Pain and Movement Impairment: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2015;38(5):324-34.[Crossref] [PubMed] 

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