Thoracic Manipulation Versus Myofascial Release in Patients With Shoulder Impingement Syndrome

Thoracic Manipulation Versus Myofascial Release in Patients With Shoulder Impingement Syndrome

aims: • To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on pain intensity.

• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on pain pressure threshold.
• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on shoulder proprioception.
• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on shoulder range of motion(ROM).
• To investigate the effect of adding thoracic manipulation vs myofascial release to scapular stabilization exercise on disability of shoulder and hand questionnaire(DASH).

Various researches have been done on rehabilitation of shoulder impingement by addressing either osseous structure or myofascial structure and found to be effective. But no studies could retrieve to compare these two: myofascial release and thoracic manipulation. (Dash & Deepak, 2020). so in this study we will investigate the effect of adding thoracic manipulation versus myofascial release in patients with shoulder impingement syndrome. we will investigate the effect on each of the following: pain intensity will measure by visual analogue scale.(VAS).

proprioception of the shoulder by isokinetic dynamometer. pain pressure threshold by algometer. function by DASH questionnaire and finally ROM by kinovea software.

The subjects will be arranged into three groups: Group I (control group) will receive scapular stabilization exercises.

• Group II will receive scapular stabilization exercises and thoracic manipulation combined with shoulder mobilization.
• Group III will receive scapular stabilization exercises and myofascial release by instrument assisted soft tissue mobilization techniques(IASTM).

the measurements will take before and after treatment programs and after one month of follow up.

Inclusion Criteria:

1. Sixty patients with shoulder impingement syndrome from both genders their age will be ranged and divided into three groups from 25-40 years.
2. History of shoulder pain for at least one month.
3. Positive Neer's impingement test and Hawkins's kiennedy test.
4. Presence of thoracic hypomobility from clinical evaluation.
5. Provocation of pain above 60 degrees of flexion and abduction.
6. Palpable trigger points on shoulder muscles.

Exclusion Criteria:

1. History of Shoulder girdle fracture, dislocation and surgery
2. Diagnosed with frozen shoulder or rotator cuff tear
3. History of cervicobrachial pain
4. Any neuromuscular pain in upper limb and use of corticosteroids or pain subsiding medication