The Effect of Thoracic Mulligan Mobilization on Sub-acromial Impingement Syndrome

NCT ID: NCT04801732

Last Updated: 2023-03-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 74 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-08-01
• Study Completion Date: 2022-11-30

Brief Summary

This study was conducted to investigate the effect of mulligan thoracic sustained natural apophyseal glide on patients diagnosed as sub acromial impingement syndrome and its effect on shoulder range of motion, pain, function and disability of affected shoulder joint and size of sub acromial space, Half of the patients will treated with traditional treatment and mulligan thoracic SNAGS technique, while the other half will treated with traditional treatment only.

Detailed Description

Forty patients with sub-acromial impingement syndrome will participate in this study. Intervention for the both group consisted of 12 session (3 times per week ) for one month. Subjects will be divided randomly and allocated into two groups , study group will received supervised exercise and mulligan thoracic SNAGS technique and the control group will received supervised exercise (stretching and strengthening exercises). both group will assessed by x ray to measure sub-acromial space , visual analogue scale for pain , The Shoulder Pain and Disability Index for shoulder function and goniometer for shoulder flexion, abduction ,external and internal rotation range of motion before and after treatment.

Conditions

Shoulder Impingement Syndrome

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

mulligan group

Patients in the study group will treated with SNAGS techniques on thoracic spine with traditional treatment consist of ice application, supervised exercises (stretching and strengthening exercise) for 3 times/week for one month.

Group Type: EXPERIMENTAL

mulligan thoracic Sustained Natural Apophyseal Glides

Intervention Type: OTHER

Extension Thoracic Sustained Natural Apophyseal Glides :

Patient position: The patient sits astride the end of the table with hands placed behind the neck to protract the scapulae allowing access to the mid thoracic spine for the therapist's hand.

Therapist position: Therapist stands on their most efficient side for a centrally applied Sustained Natural Apophyseal Glides.

Therapist grasp: The therapist's mobilizing hand (ulnar border) will apply a cephalad glide in line with the facet joint plane of the involved spinal level and the other arm holds the thoracic wall above the level to be mobilized.

Traction is applied prior to glide, which is achieved by therapist knee extension

Repetitions: Three sets of ten repetitions will be done after a trial for the patient to be familial with the technique.

and traditional treatment.

exercising group

will receive only traditional treatment (ice application and supervised exercise ) for 3 times/week for one month.

Group Type: ACTIVE_COMPARATOR

traditional treatments

Intervention Type: OTHER

includes: Ice pack and Pendulum exercise and shoulder range of motion (elevation, depression, flexion, abduction, rotations).Stretching exercise for internal rotators and posterior capsule.

Strengthening exercise will be isometric in nature include external shoulder rotators, internal rotators, biceps, deltoid, and scapular stabilizers (rhomboids, trapezius, serratus anterior, Latissimus Dorsi , and pectoralis major muscles).

Interventions

mulligan thoracic Sustained Natural Apophyseal Glides

Extension Thoracic Sustained Natural Apophyseal Glides :

Patient position: The patient sits astride the end of the table with hands placed behind the neck to protract the scapulae allowing access to the mid thoracic spine for the therapist's hand.

Therapist position: Therapist stands on their most efficient side for a centrally applied Sustained Natural Apophyseal Glides.

Therapist grasp: The therapist's mobilizing hand (ulnar border) will apply a cephalad glide in line with the facet joint plane of the involved spinal level and the other arm holds the thoracic wall above the level to be mobilized.

Traction is applied prior to glide, which is achieved by therapist knee extension

Repetitions: Three sets of ten repetitions will be done after a trial for the patient to be familial with the technique.

and traditional treatment.

Intervention Type: OTHER

traditional treatments

includes: Ice pack and Pendulum exercise and shoulder range of motion (elevation, depression, flexion, abduction, rotations).Stretching exercise for internal rotators and posterior capsule.

Strengthening exercise will be isometric in nature include external shoulder rotators, internal rotators, biceps, deltoid, and scapular stabilizers (rhomboids, trapezius, serratus anterior, Latissimus Dorsi , and pectoralis major muscles).

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Patients referred as sub-acromial impingement syndrome (stage 2) according to neer's classification.

2. Have +ve Neer's sign, +ve Hawkins and Kennedy test and +ve Empty and full can tests.

3. selected from both genders.

4. Aged from 25 to 40 years old.

5. Have restricted thoracic extension motion ( +ve occiput to wall test).

Exclusion Criteria

1. History of shoulder adhesive capsulitis

2. Rotator cuff tendon tear/rupture (stage 3).

3. Shoulder dislocation, subluxation and fractures.

4. History of cervical, shoulder, upper back surgery.

5. Any spinal deformities such as scoliosis, kyphosis and rounded shoulder.

6. Diabetes mellitus.

7. Radiculopathy.

8. History of breast cancer.

9. Previous stroke or Shoulder hand syndrome.

10. Ligamentous Laxity.

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cairo University

OTHER

Sponsor Role: lead

Responsible Party

Fatma Al-Zahraa Ahmad Alaa Aldin Mansour Abo-oof

physical therapist

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Shimaa T Abu EL-Kasem, PhD

Role: PRINCIPAL_INVESTIGATOR

Cairo University

Locations

faculty of physical therapy - Cairo university

Cairo, , Egypt

Countries

Egypt

Other Identifiers

faculty of physical therapy

Identifier Type: OTHER

Identifier Source: secondary_id

Basic Science PT

Identifier Type: -

Identifier Source: org_study_id