PMT Versus IASTM in Subacromial Impingement Syndrome

Emre DANSUK42 enrolled

Overview

This assessor-blinded, three-arm, parallel-group randomized controlled trial will investigate 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 will be 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 will be conducted as a parallel-group, assessor-blinded randomized controlled trial with a 1:1:1 allocation ratio. Forty-eight eligible participants will be 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 will be computer-generated using Randomizer.org by an independent researcher who will not be involved in participant recruitment, intervention delivery, or outcome assessment. Because of the nature of the interventions, blinding of participants and treating physiotherapists will not be possible. Outcome assessments will be conducted by an independent physiotherapist who will be blinded to group allocation. Statistical analyses will be performed by a biostatistician who will be blinded to the coded group assignments. All participants will receive a standardized conventional physiotherapy programme for four weeks. Participants assigned to the percussion massage therapy and instrument-assisted soft tissue mobilization groups will additionally receive the corresponding soft-tissue intervention three times per week for four weeks. Outcome assessments will be performed at baseline and immediately after completion of the four-week intervention. The primary outcome will be shoulder joint position sense during flexion and abduction. Secondary outcomes will include 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 will be administered using a handheld Hypervolt device (Hyperice, California, USA) at 33 Hz, corresponding to level 2 of the device. A flat-head attachment will be used to provide uniform contact with the treated tissues. The intervention will be applied to the deltoid, supraspinatus, infraspinatus, and teres minor muscles along their anatomical fibre orientation. Each muscle will be treated for three minutes using controlled longitudinal strokes applied alternately in proximal-to-distal and distal-to-proximal directions. The intervention will last 12 minutes per session and will be administered by the same licensed physiotherapist three times per week for four weeks. It will be provided in addition to the 30-minute conventional physiotherapy programme, resulting in a total session duration of 42 minutes.

Instrument-assisted soft tissue mobilization deviceDEVICE

Instrument-assisted soft tissue mobilization will be administered to the deltoid, supraspinatus, infraspinatus, and teres minor muscles three times per week for four weeks. All applications will be performed by the same licensed physiotherapist. Standardized sweep and brush stroke techniques will be applied at an approximate treatment angle of 45° according to the anatomical fibre orientation of each muscle. For each muscle, 90 seconds of parallel strokes will be followed by 90 seconds of perpendicular strokes using controlled sweeping movements. The intervention will last three minutes per muscle and 12 minutes per session. It will be provided in addition to the 30-minute conventional physiotherapy programme, resulting in a total session duration of 42 minutes.

Conventional PhysiotherapyOTHER

Participants will receive supervised conventional physiotherapy from a licensed physiotherapist five times weekly for four weeks. Each standard 30-minute session will include 20 minutes of TENS to the symptomatic shoulder at 100 Hz and 10 minutes of exercise. Exercises will comprise wand-assisted shoulder movements, Codman pendulum exercises, active and passive stretching, finger-ladder exercises, and elastic-band strengthening for flexion, abduction, extension, and internal and external rotation. Exercises will be performed for 10 repetitions per set, with resistance progressed according to pain, function, and tolerance. To match treatment duration and therapist contact, the control group will perform an additional standardized 12-minute exercise block during three sessions weekly, including one extra set of range-of-motion and resistance exercises. Sessions will therefore last 42 minutes on three days and 30 minutes on two days weekly.

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