The Effectiveness of Routine Physiotherapy with and Without Neuromobilization in Patients with Shoulder Impingement Syndrome

Abstract

Background: Shoulder pain is a major problem experienced by people during life time. Shoulder impingement syndrome is one of the major causes of shoulder pain. Objective: To evaluate the effectiveness of neuromobilization on the pain, range of motion, shoulder strength and functional disability score in participants with shoulder impingement syndrome. Methods: A single blinded randomized controlled trial was conducted in Social Security Hospital, Gujranwala. Data was collected from august 2016 to February 2018.Total 80 participants who had fulfilled the inclusion criteria were selected by simple random sampling and were allocated into control and experimental group through random allocation sequence. After the baseline assessment routine physiotherapy was executed for both groups, while neuromobilization was applied to experimental group. Pain, shoulder range of motion, shoulder muscle strength and functional disability score were evaluated on baseline, 5 th and 11th week. The data were analyzed using SPSS (version 22.0). Results: After the treatment, significant improvement was observed group wise at post treatment and 1st follow up from baseline. Shoulder active forward flexion was 124.00⸰±18.74 at baseline and 147.12⸰±15.25 after 1st follow up that were significantly in experimental group, similarly shoulder abduction was also significantly improved in experimental group. Pain at baseline was 6.95±1.189 (unmanageable); and after 1st follow up was 2.15±1.55 (mild pain). The University of California and Los Angeles mean score for experimental group was 14.05±2.59 (poor) and 28.58±3.89 (good) at baseline and 11th week respectively. 2 In control group shoulder active flexion was 111.50⸰±15.88 at baseline and 123.45⸰±15.36 after 1st follow up, shoulder abduction was 95.88⸰±11.51 at baseline and 104.65⸰±12.98 after 1st follow up, these results insignificantly improved in control group. The University of California Los Angeles mean score for control group was 14.50±2.37 (poor) and 20.10±4.08 (poor) at baseline and 11th week. Pain at baseline was 6.78±1.05 (unmanageable) and on 1st follow up was 4.90±1.58 (distracting); these results showed that pain was improved but not significantly in control group. Strength of forward flexor and shoulder abductors strength in control and experimental group was statistically significant with p-value < 0.001. Conclusion: Overall results suggest that neuromobilization technique is an effective treatment for improving shoulder strength, The University of California and Los Angeles score and improving shoulder abduction and active forward flexion and pain for 5 to 11 weeks period following treatment for shoulder impingement syndrome as opposed to routine physiotherapy. Keywords: shoulder impingement syndrome, range of motion, pain, tendinopathy.