This study will be conducted to investigate the combined effect of thoracic manipulation and instrument-assisted soft tissue mobilization in patients with shoulder impingement syndrome
Shoulder impingement syndrome (SIS) represents one of the most prevalent musculoskeletal disorders affecting the upper extremity, accounting for 44-65% of all shoulder complaints in clinical practice. The condition is characterized by mechanical compression of the rotator cuff tendons and subacromial bursa beneath the coracoacromial arch during arm elevation, resulting in pain, inflammation, and reduced quality of life. Thoracic spinal manipulation aims to restore mobility and optimize scapular positioning. Studies have shown that adding Maitland thoracic manipulation or Mulligan SNAGs to exercise leads to superior improvements in pain and range of motion.Thoracic spine manipulation (TSM) is one of the techniques that can be used to gain thoracic mobility in peoples with shoulder dysfunction Instrument-assisted soft tissue mobilization (IASTM) uses specialized tools to treat myofascial restrictions. It triggers a localized inflammatory response that initiates healing and remodeling. While promising in tendinopathy cases, there is a significant evidence gap regarding its efficacy when combined with joint-based manual therapy for SIS. Investigating the synergistic effects of combining these regional and local interventions with foundational scapular stabilization exercises will provide a comprehensive, evidence-based framework that is currently lacking in the literature.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
80
the patients will receive conventional physical therapy in the form of transcutaneous electrical nerve stimulation, ultrasound, and therapeutic exercise. The exercise includes range of motion exercises, stretching, scapular stabilization exercises, and rotator cuff strengthening.
With the participant in a prone position, the therapist will apply a high-velocity, short-lever, posterior-to-anterior (P-A) thrust. The thrust will be directed toward the spinous or transverse processes of the hypomobile thoracic vertebrae. Thoracic thrust manipulation demonstrated to manipulate specific thoracic segment mainly the mid-thoracic, plus conventional physical therapy.
upper limb disability
Disabilities of the arm, shoulder and hand (Quick DASH) questionnaire will be used toassess upper limb diability.the QuickDASH only contains 11 items .It is a questionnaire that measures an individual's ability to complete tasks, absorb forces, and severity of symptoms.The QuickDASH tool uses a 5-point Likert scale from which the patient can select an appropriate number corresponding to his/her severity/function level.The QuickDASH outcome measure is designed to be used on patients presenting with one or more disabilities of the arm, shoulder, and hand. Scoring with 100 is more severe disability, and zero mean no disability.
Time frame: up to six weeks
pain intensity
neumerical pain rating scale will be used to assess pain. It consists of a line, often 10 cm long (100mm); its ends are generally labelled with verbal pain anchors (e.g., "no pain" and "pain as bad as it could be"). Patients are asked to indicate the point along the line from 0-10 cm marked in 1 cm increments where 0 cm represents no pain and 10 cm the most severe pain imaginable
Time frame: up to 6 weeks
shoulder range of motion
The Digital goniometer will be used to assess shoulder range of motion.
Time frame: up to six weeks
shoulder proprioception (joint position error)
shoulder joint position error will be assessed by a smartphone clinometer application. Proprioception test was done by moving the participant's arms from the starting position (0 degrees) to the target angles. The arm remained at each target angle for 5 seconds, allowing the subjects to memorize the position before returning to the starting position. Subsequently, the subjects were instructed to independently move their arms towards each target angle.
Time frame: up to six weeks
life disability
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
The IASTM technique will be 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° angle to the skin. The beveled side of the M2T blade will be in contact with the skin. Stroke pressure and speed will be modified according to the participant's tolerance to avoid causing pain and according to the depth of the treated muscle plus conventional physical therapy.The technique will be applied to the pectoral muscles, shoulder rotator cuff musculature, and periscapular musculature, including the upper, middle, and lower fibers of the trapezius, rhomboids major and minor, teres major, and latissimus dorsi
the patients will receive The IASTM technique will be 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° angle to the skin plus thoracic manibulation in which the therapist will apply a high-velocity, short-lever, posterior-to-anterior (P-A) thrust. The thrust will be directed toward the spinous or transverse processes of the hypomobile thoracic vertebrae. Thoracic thrust manipulation demonstrated to manipulate specific thoracic segments, mainly the mid-thoracic, plus conventional physical therapy. finally, the pateitns will recieve conventional physical therapy
World Health Organization Quality of Life BREF will be used to assess life disability. The WHOQOL-BREF is a 26-item instrument that assesses quality of life across four domains: physical health (items 3, 4, 10, 15, 16, 17, and 18), psychological health (items 5, 6, 7, 11, 19, and 26), social relationships (items 20, 21, and 22), and environment (items 8, 9, 12, 13, 14, 23, 24, and 25). Items 1 and 2 assess overall quality of life and general health, respectively. Each item is rated on a 5-point Likert scale from 1 to 5. Items 3 and 4 are reverse-scored. For each domain, the item scores are averaged and multiplied by 4, producing a domain score ranging from 4 to 20, with higher scores indicating better quality of life.
Time frame: up to six weeks
pressure pain threshold
pressure pain threshold wil be assessed by algometer.During the assessment, the patient is instructed to indicate the exact moment the sensation transitions from comfortable pressure to the onset of pain, effectively translating a subjective experience into an objective, measurable value (typically recorded in kg/cm² or Newtons).
Time frame: up to six weeks