The effect of spinal mobilisation with arm movement and a Maitland mobilisation on range of motion and muscle activity in overhead athletes with subacromial impingement syndrome - A randomised clinical trial
Date
2022
Authors
Antonysamy, Ignatius Richard
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Abstract
Background: After back pain and neck pain, shoulder discomfort is the third most common orthopaedic issue in Australia. The most frequent cause of shoulder pain is impingement syndrome, which is widespread in overhead sports activities. To treat shoulder discomfort, physiotherapists employ a variety of manual treatment approaches. According to certain researchers, there is a neurophysiological link between the shoulder and the cervical spine. However, there are not too many research that show how manual treatment in the neck may relieve shoulder discomfort. Establishing a connection between the shoulder and cervical spine can aid in a successful and quick recovery.
Purpose: This study aims to determine and compare any changes in shoulder muscle activity and range of movement (ROM) in relation to spinal mobilisation with arm movement and a
Maitland technique in overhead athletes with subacromial impingement syndrome.
Method: Athletes from contact and non-contact sports were given an information sheet. Forty athletes were selected to participate in this study after obtaining the signed informed
consent form. Ethical approval was provided by the Human Research Committee (HREC) of the University of Witwatersrand, and the protocol was registered in the Pan African clinical trials registry. Each participant completed a questionnaire comprised of personal, sports, and medical history questions. Apart from the questionnaire, participants also completed the Shoulder pain and Stability Index (SPADI) and Visual Analogue Scale (VAS).
Forty athletes were randomised and allocated into two groups, namely the Mulligan and Maitland group, and each group was equal to 20 participants. The group allocation was
blindfolded to the researcher. The Electromyography (EMG), Range of Motion (ROM), and VAS scores were the outcomes determined before and after the mobilisations. Mulligan
group athletes received the Spinal mobilisation with arm movement (SMWAM) technique on the painful side of C5/6, and the Maitland group received 30 PA oscillations on the painful
side of C5/6 level. ROM was measured using the joint range of motion (JROM) 3D sensor and application, and the value was recorded in the data sheet. In addition, the EMG of upper
fibres of trapezius, lower trapezius, and serratus anterior were recorded, and raw data were stored in a computer for statistical analysis.
Data were collected and managed in Microsoft Excel 2011 version. The researcher then exported and analysed the data using STATA software version 15. Data were not distributed
normally, and non-parametric tests were used. The t-test was used to determine the changes in each group for the VAS, SPADI, ROM, and EMG scores. An ANOVA two-way repeated test was used to compare the difference between the groups over time. A p-value of the study was set at p<0.05 to establish a statistical significance.
Results: Each group was analysed separately, and both groups were compared. Apart from main outcomes (VAS, EMG, and ROM), demographic characteristics and SPADI scores were also analysed. There were no significant differences between the groups in age (p=0.4), gender(p=0.3) height (p=0.7) and weight (p=0.9). Data was analysed before and after the mobilisation. There were significant changes in VAS, EMG, ROM, and SPADI post mobilisation compared to pre mobilisation. However, no better technique could be found as the groups had no significant statistical difference. This study supports the neural relationship between cervical vertebrae and shoulder pain.
Conclusion:
This study found a reduction of pain, muscle activity, and increase of ROM in SAIS when mobilising the cervical region. Current medical practice has limited evidence regarding conservative management. However, mobilising cervical vertebrae could contribute to faster shoulder rehabilitation recovery. Both groups, Maitland and Mulligan, showed significant improvement in VAS, ROM, and muscle activity ( p- 0.05 ). However, both techniques were compared statistically and found no significant differences
Description
A dissertation submitted in fulfillment of the requirements for the degree of Master of Science in Physiotherapy to the Faculty of Health Sciences, School of Therapeutic Sciences
University of the Witwatersrand, Johannesburg, 2022