Thoracic Manipulation Versus Myofascial Release in Patients With Shoulder Impingement Syndrome

NCT ID: NCT05104671

Last Updated: 2025-07-24

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-12-01
• Study Completion Date: 2023-05-15

Brief Summary

aims: • To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on pain intensity.

• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on pain pressure threshold.
• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on shoulder proprioception.
• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on shoulder range of motion(ROM).
• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on disability of shoulder and hand questionnaire(DASH).

Detailed Description

Various researches have been done on rehabilitation of shoulder impingement by addressing either osseous structure or myofascial structure and found to be effective. But no studies could retrieve to compare these two: myofascial release and thoracic manipulation. (Dash & Deepak, 2020). so in this study we will investigate the effect of adding thoracic manipulation versus myofascial release in patients with shoulder impingement syndrome. we will investigate the effect on each of the following: pain intensity will measure by visual analogue scale.(VAS).

proprioception of the shoulder by isokinetic dynamometer. pain pressure threshold by algometer. function by DASH questionnaire and finally ROM by kinovea software.

The subjects will be arranged into three groups: Group I (control group) will receive scapular stabilization exercises.

• Group II will receive scapular stabilization exercises and thoracic manipulation combined with shoulder mobilization.
• Group III will receive scapular stabilization exercises and myofascial release by instrument assisted soft tissue mobilization techniques(IASTM).

the measurements will take before and after treatment programs and after one month of follow up.

Conditions

Impingement Shoulder

Study Design

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

Study Groups

Scapular stabilization exercises

Group I (control group) will receive scapular stabilization exercises.

Group Type: ACTIVE_COMPARATOR

scapular stabilization exercises.

Intervention Type: OTHER

General Instructions: For all exercises, perform the retraction of the scapula, without performing the elevation of the shoulders, taking the lower angle of the scapula "back and down".

The exercise intensity was described as repetitions, sets, and holding time. Commonly, 10-20 repetitions and three to five sets held for 3-10 seconds were performed.and the exercises will be:

1. towel slide

2. Scapular Clock:

3. Scapular Proprioceptive Neuromuscular facilitation:

4. Inferior Glide.

5. Scapular Orientation Exercise (SOE):

6. Protraction and retraction in front of a mirror:

Thoracic manipulation.

Group II will receive scapular stabilization exercises and thoracic manipulation.

Group Type: EXPERIMENTAL

scapular stabilization exercises.

Intervention Type: OTHER

General Instructions: For all exercises, perform the retraction of the scapula, without performing the elevation of the shoulders, taking the lower angle of the scapula "back and down".

The exercise intensity was described as repetitions, sets, and holding time. Commonly, 10-20 repetitions and three to five sets held for 3-10 seconds were performed.and the exercises will be:

1. towel slide

2. Scapular Clock:

3. Scapular Proprioceptive Neuromuscular facilitation:

4. Inferior Glide.

5. Scapular Orientation Exercise (SOE):

6. Protraction and retraction in front of a mirror:

Thoracic manipulation.

Intervention Type: OTHER

• Thoracic Thrust Manipulation: The participants were in high sitting and in prone lying position. The therapist was standing next to the patient in a diagonal stance and also behind the patient during high sitting. Thoracic thrust manipulation demonstrated to manipulate specific thoracic segment mainly mid thoracic.

Myofascial release

Group III will receive scapular stabilization exercises and myofascial release by instrument assisted soft tissue mobilization techniques.

Group Type: EXPERIMENTAL

scapular stabilization exercises.

Intervention Type: OTHER

General Instructions: For all exercises, perform the retraction of the scapula, without performing the elevation of the shoulders, taking the lower angle of the scapula "back and down".

The exercise intensity was described as repetitions, sets, and holding time. Commonly, 10-20 repetitions and three to five sets held for 3-10 seconds were performed.and the exercises will be:

1. towel slide

2. Scapular Clock:

3. Scapular Proprioceptive Neuromuscular facilitation:

4. Inferior Glide.

5. Scapular Orientation Exercise (SOE):

6. Protraction and retraction in front of a mirror:

Myofascial release.

Intervention Type: OTHER

The subject will be treated with IASTM.applied to the pectoral muscles and medial brachium with the subject in supine and the glenohumeral joint(GH). placed in 120 º abduction to place adequate tension on the selected tissues in the style of pectoral tightness test .The IASTM technique was performed for 20 seconds parallel to the muscle fibers followed by 20 seconds perpendicular to the muscle fibers with the instrument held at a 45 º angle to the skin.The same IASTM protocol of 20 seconds parallel to the muscle fibers and 20 seconds perpendicular to the muscle fibers was applied to the posterior cuff musculature of the GH joint with the subject in prone and arms in 90 º abduction and internal rotation draped over the side of the plinth . While in the same position, the technique was applied to the periscapular musculature including the, trapezoids, rhomboids, teres minor, teres major, and latissimus dorsi.

Interventions

scapular stabilization exercises.

General Instructions: For all exercises, perform the retraction of the scapula, without performing the elevation of the shoulders, taking the lower angle of the scapula "back and down".

The exercise intensity was described as repetitions, sets, and holding time. Commonly, 10-20 repetitions and three to five sets held for 3-10 seconds were performed.and the exercises will be:

1. towel slide

2. Scapular Clock:

3. Scapular Proprioceptive Neuromuscular facilitation:

4. Inferior Glide.

5. Scapular Orientation Exercise (SOE):

6. Protraction and retraction in front of a mirror:

Intervention Type: OTHER

Thoracic manipulation.

• Thoracic Thrust Manipulation: The participants were in high sitting and in prone lying position. The therapist was standing next to the patient in a diagonal stance and also behind the patient during high sitting. Thoracic thrust manipulation demonstrated to manipulate specific thoracic segment mainly mid thoracic.

Intervention Type: OTHER

Myofascial release.

The subject will be treated with IASTM.applied to the pectoral muscles and medial brachium with the subject in supine and the glenohumeral joint(GH). placed in 120 º abduction to place adequate tension on the selected tissues in the style of pectoral tightness test .The IASTM technique was performed for 20 seconds parallel to the muscle fibers followed by 20 seconds perpendicular to the muscle fibers with the instrument held at a 45 º angle to the skin.The same IASTM protocol of 20 seconds parallel to the muscle fibers and 20 seconds perpendicular to the muscle fibers was applied to the posterior cuff musculature of the GH joint with the subject in prone and arms in 90 º abduction and internal rotation draped over the side of the plinth . While in the same position, the technique was applied to the periscapular musculature including the, trapezoids, rhomboids, teres minor, teres major, and latissimus dorsi.

Intervention Type: OTHER

Other Intervention Names

scapular stabilization exercises; scapular stabilization exercises

Eligibility Criteria

Inclusion Criteria

1. Sixty patients with shoulder impingement syndrome from both genders their age will be ranged and divided into three groups from 25-40 years.

2. History of shoulder pain for at least one month.

3. Positive Neer's impingement test and Hawkins's kiennedy test.

4. Presence of thoracic hypomobility from clinical evaluation.

5. Provocation of pain above 60 degrees of flexion and abduction.

6. Palpable trigger points on shoulder muscles.

Exclusion Criteria

1. History of Shoulder girdle fracture, dislocation and surgery

2. Diagnosed with frozen shoulder or rotator cuff tear

3. History of cervicobrachial pain

4. Any neuromuscular pain in upper limb and use of corticosteroids or pain subsiding medication

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

Sponsors

Cairo University

OTHER

Sponsor Role: collaborator

manar sameh el taher

OTHER

Sponsor Role: lead

Responsible Party

manar sameh el taher

Researcher

Responsibility Role: SPONSOR_INVESTIGATOR

Locations

Cairo University

Cairo, , Egypt

Countries

Egypt

Other Identifiers

shoulder impingement

Identifier Type: -

Identifier Source: org_study_id