The Combined Effect of Thoracic Manipulation and Instrument-assisted Soft Tissue Mobilization in Patients With Shoulder Impingement Syndrome

The Combined Effect of Thoracic Manipulation and Instrument-assisted Soft Tissue Mobilization in Patients With Shoulder Impingement Syndrome

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.

Inclusion Criteria:

• Patients with shoulder impingement syndrome from both genders their age from 18-55 years.
• History of shoulder pain for one month.
• Positive Neer's impingement test and Hawkin's Kennedy test.
• Painful arc sign.

Exclusion Criteria:

• History of Shoulder girdle fracture, dislocation and surgery
• Diagnosed with frozen shoulder or rotator cuff tear
• History of cervicobrachial pain
• Any neuromuscular pain in upper limb and use of corticosteroids or pain subsiding medication.
• Inflammatory arthropathies (e.g., rheumatoid arthritis, ankylosing spondylitis).
• Fracture or malignancy in the shoulder region
• Contraindications to manual therapy or thoracic manipulation (e.g., osteoporosis, spinal cord compression, vertebral artery insufficiency).
• Contraindications to IASTM (e.g., open wounds, skin infections, bleeding disorders, anticoagulant therapy).