Thoracic Manual Therapy Improves Pain and Disability in Individuals With Shoulder Impingement Syndrome Compared With Placebo: A Randomized Controlled Trial With 1-Year Follow-up.
Study Goal
To determine whether muscle energy technique (MET) with or without soft tissue massage (STM) reduces pain and disability in individuals with shoulder impingement syndrome (SIS).
Results Summary
MET alone significantly improved pain and disability (measured by DASH, SPADI, and VAS) compared to placebo at discharge, 6 months, and 12 months. MET+STM improved disability but not pain compared to placebo, with no significant differences between MET-only and MET+STM groups.
Population
Adults aged 40+ with shoulder impingement syndrome (N=75).
Effective Dosage
Once a week for 15 minutes, 4 consecutive weeks.
Duration
4 weeks (intervention), 12 months (follow-up).
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
MET to the thoracic spine (MET-only) | decrease | pain and disability (DASH) | participants 40 years or older with SIS | mean difference DASH=-8.4 at discharge | demonstrated significantly greater improvement | #1 |
MET to the thoracic spine (MET-only) | decrease | pain and disability (SPADI) | participants 40 years or older with SIS | mean difference SPADI=-14.7 at discharge | demonstrated significantly greater improvement | #2 |
MET to the thoracic spine (MET-only) | decrease | pain (VAS 7-day average) | participants 40 years or older with SIS | mean difference VAS=-15.5 at discharge | demonstrated significantly greater improvement | #3 |
MET to the thoracic spine (MET-only) | decrease | pain and disability (DASH) | participants 40 years or older with SIS | mean difference DASH=-11.1 at 6 months | demonstrated significantly greater improvement | #4 |
MET to the thoracic spine (MET-only) | decrease | pain and disability (SPADI) | participants 40 years or older with SIS | mean difference SPADI=-14.9 at 6 months | demonstrated significantly greater improvement | #5 |
MET to the thoracic spine (MET-only) | decrease | pain (VAS 7-day average) | participants 40 years or older with SIS | mean difference VAS=-14.1 at 6 months | demonstrated significantly greater improvement | #6 |
MET to the thoracic spine (MET-only) | decrease | pain and disability (DASH) | participants 40 years or older with SIS | mean difference DASH=-13.4 at 12 months | demonstrated significantly greater improvement | #7 |
MET to the thoracic spine (MET-only) | decrease | pain and disability (SPADI) | participants 40 years or older with SIS | mean difference SPADI=-19.0 at 12 months | demonstrated significantly greater improvement | #8 |
MET to the thoracic spine (MET-only) | decrease | pain (VAS 7-day average) | participants 40 years or older with SIS | mean difference VAS=-17.3 at 12 months | demonstrated significantly greater improvement | #9 |
MET plus soft tissue massage (MET+STM) | decrease | disability (DASH) | participants 40 years or older with SIS | mean difference DASH=-8.2 at discharge | demonstrated greater improvement | #10 |
MET plus soft tissue massage (MET+STM) | decrease | disability (SPADI) | participants 40 years or older with SIS | mean difference SPADI=-13.5 at discharge | demonstrated greater improvement | #11 |
MET plus soft tissue massage (MET+STM) | decrease | disability (DASH) | participants 40 years or older with SIS | mean difference DASH=-9.0 at 6 months | demonstrated greater improvement | #12 |
MET plus soft tissue massage (MET+STM) | decrease | disability (SPADI) | participants 40 years or older with SIS | mean difference SPADI=-12.4 at 6 months | demonstrated greater improvement | #13 |
MET to the thoracic spine (MET-only) | increase | Patient-Specific Functional Scale (PSFS) | participants 40 years or older with SIS | 1.3 at discharge | improved compared with placebo | #14 |
MET to the thoracic spine (MET-only) | increase | Patient-Specific Functional Scale (PSFS) | participants 40 years or older with SIS | 1.8 at 12 months | improved compared with placebo | #15 |
MET plus soft tissue massage (MET+STM) | increase | Patient-Specific Functional Scale (PSFS) | participants 40 years or older with SIS | 1.7 at 12 months | improved compared with placebo | #16 |
MET to the thoracic spine (MET-only) | increase | Global Rating of Change (GROC) | participants 40 years or older with SIS | 1.5 at discharge | improved compared with placebo | #17 |
MET to the thoracic spine (MET-only) | increase | Global Rating of Change (GROC) | participants 40 years or older with SIS | 1.0 at 4 weeks | improved compared with placebo | #18 |
MET plus soft tissue massage (MET+STM) | increase | Global Rating of Change (GROC) | participants 40 years or older with SIS | 1.2 at discharge | improved compared with placebo | #19 |
MET plus soft tissue massage (MET+STM) | increase | Global Rating of Change (GROC) | participants 40 years or older with SIS | 1.2 at 6 months | improved compared with placebo | #20 |
MET to the thoracic spine (MET-only) | no change | pain and disability | participants 40 years or older with SIS | - | no differences between | #21 |
MET plus soft tissue massage (MET+STM) | no change | pain and disability | participants 40 years or older with SIS | - | no differences between | #22 |
MET to the thoracic spine (MET-only) | no change | thoracic posture | participants 40 years or older with SIS | - | no between-group differences | #23 |
MET to the thoracic spine (MET-only) | no change | thoracic range of motion (ROM) | participants 40 years or older with SIS | - | no between-group differences | #24 |
MET plus soft tissue massage (MET+STM) | no change | thoracic posture | participants 40 years or older with SIS | - | no between-group differences | #25 |
MET plus soft tissue massage (MET+STM) | no change | thoracic range of motion (ROM) | participants 40 years or older with SIS | - | no between-group differences | #26 |
OBJECTIVE: To investigate whether muscle energy technique (MET) to the thoracic spine decreases the pain and disability associated with shoulder impingement syndrome (SIS). DESIGN: Single-center, 3-arm, randomized controlled trial, single-blind, placebo control with concealed allocation and a 12-month follow-up. SETTING: Private osteopathic practice. PARTICIPANTS: Three groups of 25 participants (N=75) 40 years or older with SIS received allocated intervention once a week for 15 minutes, 4 consecutive weeks. INTERVENTIONS: Participants were randomly allocated to MET to the thoracic spine (MET-only), MET plus soft tissue massage (MET+STM), or placebo. MAIN OUTCOME MEASURES: Primary outcome measure: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. SECONDARY OUTCOME MEASURES: Shoulder Pain and Disability Index (SPADI) questionnaire; visual analog scale (VAS) (mm/100): current, 7-day average, and 4-week average; Patient-Specific Functional Scale (PSFS); and Global Rating of Change (GROC). Measures recorded at baseline, discharge, 4-week follow-up, 6 months, and 12 months. Also baseline and discharge thoracic posture and range of motion (ROM) measured using an inclinometer. Statistical analysis included mixed-effects linear regression model for DASH, SPADI, VAS, PSFS, GROC, and thoracic posture and ROM. RESULTS: MET-only group demonstrated significantly greater improvement in pain and disability (DASH, SPADI, VAS 7-day average) than placebo at discharge (mean difference, DASH=-8.4; 95% CI, -14.0 to -2.8; SPADI=-14.7; 95% CI, -23.0 to -6.3; VAS=-15.5; 95% CI, -24.5 to -6.5), 6 months (-11.1; 95% CI, -18.6 to -3.7; -14.9; 95% CI, -26.3 to -3.5; -14.1; 95% CI, -26.0 to -2.2), and 12 months (-13.4; 95% CI, -23.9 to-2.9; -19.0; 95% CI, -32.4 to -5.7; -17.3; 95% CI, -30.9 to -3.8). MET+STM group also demonstrated greater improvement in disability but not pain compared with placebo at discharge (DASH=-8.2; 95% CI, -14.0 to -2.3; SPADI=-13.5; 95% CI, -22.3 to -4.8) and 6 months (-9.0; 95% CI, -16.9 to -1.2; -12.4; 95% CI, -24.3 to -0.5). For the PSFS, MET-only group improved compared with placebo at discharge (1.3; 95% CI, 0.1-2.5) and 12 months (1.8; 95% CI, 0.5-3.2); MET+STM at 12 months (1.7; 95% CI, 0.3-3.0). GROC: MET-only group improved compared with placebo at discharge (1.5; 95% CI, 0.9-2.2) and 4 weeks (1.0; 95% CI, 0.1-1.9); MET+STM at discharge (1.2; 95% CI, 0.5-1.9) and 6 months (1.2; 95% CI, 0.1-1.3). There were no differences between MET-only group and MET+STM, and no between-group differences in thoracic posture or ROM. CONCLUSIONS: MET of the thoracic spine with or without STM improved the pain and disability in individuals 40 years or older with SIS and may be recommended as a treatment approach for SIS.