Percussion Massage Therapy and IASTM in Subacromial Impingement Syndrome

Emre DANSUK48 enrolled

Overview

This assessor-blinded, three-arm, parallel-group randomized controlled trial investigated the additional effects of percussion massage therapy and instrument-assisted soft tissue mobilization in individuals with subacromial impingement syndrome. Forty-eight participants aged 40-60 years with clinically and magnetic resonance imaging-confirmed subacromial impingement syndrome were randomly allocated in a 1:1:1 ratio to conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy. All groups received a standardized four-week conventional physiotherapy programme. Participants in the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received their respective interventions three times per week for four weeks. Outcomes were evaluated at baseline and immediately after the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes were shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.

Subacromial impingement syndrome is commonly associated with shoulder pain, limitations in range of motion, functional disability, and impaired sensorimotor control. Exercise-based rehabilitation is considered a primary component of conservative management. Percussion massage therapy and instrument-assisted soft tissue mobilization are frequently used as adjunct soft-tissue interventions; however, comparative evidence regarding their additional effects in individuals with subacromial impingement syndrome remains limited. This study was designed as a parallel-group, assessor-blinded randomized controlled trial with a 1:1:1 allocation ratio. Forty-eight eligible participants were randomly allocated to one of three groups: conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy. The randomization sequence was computer-generated using Randomizer.org by an independent researcher who was not involved in participant recruitment, intervention delivery, or outcome assessment. Because of the nature of the interventions, participants and treating physiotherapists could not be blinded. Outcome assessments were conducted by an independent physiotherapist blinded to group allocation. Statistical analyses were conducted by a biostatistician blinded to coded group assignments. All participants received a standardized conventional physiotherapy programme for four weeks. Participants assigned to the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received the corresponding soft-tissue intervention three times per week for four weeks. Outcome assessments were performed at baseline and immediately after completion of the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes included shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.

Interventions

Percussion massage therapy deviceDEVICE

Percussion massage therapy was administered using a handheld Hypervolt device (Hyperice, California, USA) at 33 Hz, corresponding to level 2 of the device. A flat-head attachment was used to provide uniform contact with the treated tissues. The intervention was applied to the deltoid, supraspinatus, infraspinatus, and teres minor muscles along their anatomical fibre orientation. Each muscle was treated for three minutes using controlled longitudinal strokes applied alternately in proximal-to-distal and distal-to-proximal directions. The intervention was administered by the same licensed physiotherapist three times per week for four weeks, concurrently with the conventional physiotherapy programme.

Instrument-assisted soft tissue mobilization deviceDEVICE

Instrument-assisted soft tissue mobilization was administered to the deltoid, supraspinatus, infraspinatus, and teres minor muscles three times per week for four weeks. All applications were performed by the same licensed physiotherapist. Standardized sweep and brush stroke techniques were applied at an approximate treatment angle of 45 degrees and in accordance with the anatomical fibre orientation of each muscle. For each muscle, 20 seconds of parallel strokes were followed by 20 seconds of perpendicular strokes using controlled sweeping movements. The intervention was provided in addition to the conventional physiotherapy programme.

Conventional PhysiotherapyOTHER

Participants received a standardized, supervised conventional physiotherapy programme for four weeks, administered five sessions per week by a licensed physiotherapist. Each session included transcutaneous electrical nerve stimulation applied to the symptomatic shoulder for 20 minutes at 100 Hz, followed by a structured exercise programme. The exercise programme included wand-assisted active range-of-motion exercises for shoulder flexion, abduction, extension, internal rotation, and external rotation; Codman pendulum exercises; active and passive stretching; and finger ladder exercises. Progressive strengthening exercises using elastic resistance bands were performed for shoulder flexion, abduction, internal rotation, external rotation, and extension. Resistance was progressively adjusted according to pain severity, functional capacity, and treatment tolerance, while a standardized volume of 10 repetitions per set was maintained.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Men or women aged 40 to 60 years. * Diagnosis of subacromial impingement syndrome confirmed by clinical examination and -magnetic resonance imaging. * Positive Neer test. * Positive Hawkins-Kennedy test. * Positive painful arc test. * Shoulder symptoms persisting for at least one month. * Ability and willingness to participate in the assessment and intervention programme. * Provision of written informed consent. Exclusion Criteria: * Previous surgery involving the affected upper extremity. * Inflammatory joint disease. * Shoulder osteoarthritis. * Rheumatic disease. * Malignant or benign tumour affecting the shoulder region or upper extremity. * Open wound or active infection in the shoulder region. * Inability to tolerate vibration-based therapy. * Inability to comply with the study protocol or intervention programme.

Outcomes

Primary Outcomes

Change in Shoulder Joint Position Sense Error

Shoulder joint position sense was assessed using a digital goniometer at target positions of 60 degrees of shoulder flexion and 60 degrees of shoulder abduction. The affected shoulder was passively positioned at the target angle, and the participant was allowed up to 10 seconds to memorize the position. The arm was then returned to the neutral position, and the participant was asked to actively reproduce the target position with the eyes closed. The absolute angular difference between the target position and the reproduced position was calculated in degrees. Three trials were conducted for flexion and three trials for abduction, and the mean absolute error for each direction was used in the analysis. Lower values indicate greater joint position sense accuracy.