Effect of Mulligan Technique on Subacromial Impingement Syndrome: A Systematic Review

Abstract

Background: Subacromial impingement syndrome (SIS) is considered the most prevailing cause of shoulder pain. Although Mulligan's technique may be useful in treating shoulder impingement, its significance in areas of range of movement (ROM), pain, and function is still debated. Objective: To systematically review and summarize the best evidence on treating subacromial impingement syndrome using mobilization with movement. Patients and Methods: Databases Cochrane Library Web search, PEDro and PubMed were searched for RCTs published in English language from inception to September 2019, updated later to 7th of July 2021. Reference lists of relevant publications were also screened. Two reviewers separately identified relevant papers based on the inclusion criteria. The identified papers by both authors were obtained in full text. To evaluate methodological quality and risk of bias, the Cochrane risk of bias tool was used. We used the random-effects model in all analyses for meta-analyses. Results: A total of 11 RCTs with a total number of 358 adults with subacromial shoulder pain were included. They examined the effect of mobilization with movement (MWM) combined with exercise with or without taping against rotator cuff strengthening, ROM exercises, isometric strengthening, shoulder joint mobilization, and sham techniques. Meta-analysis was done comparing MWM against exercise and found a significant difference in VAS and a non-significant difference in SPADI. Conclusion: Shoulder mobilization with movement combined with a supervised exercise program (ROM, and functional limitations) has a better impact on pain than exercise alone or sham in short-term with similar improvement to exercise in the long-term.

Effect of Maitland and Mulligan mobilization on pain, range of motion and disability in patients with rotator cuff syndrome: a randomized clinical trial protocol

“…Both groups' patient satisfaction with the course of treatment was comparable (p = 0.28). According to the findings of the study, patients with SAIS respond to both supervised exercise and mobilisation in a similar way, Ferit Pekgöz et al 18…”

“…The overall number of people with subacromial shoulder discomfort included in this study was 358 across 11 RCTs, they compared the efficiency of MWM combined with exercise for rotator cuff mobilisation, isometric, ROM, strengthening and sham techniques. There was a non-significant difference in SPADI but a significant difference in VAS when MWM was compared to exercise, according to a meta-analysis by Mohamed Abdellatif Hassan et al (2021). 17 In another study, joint mobilisation paired with supervised exercise were examined in people with subacromial impingement syndrome (SAIS), between June 2014 and June 2015, 40 participants with SAIS for longer than six weeks were enrolled in this randomized-controlled research.…”

Effect of Low-Level Laser with and without Shoulder Mobilization in Treating Shoulder Impingement

“…Previous studies reported that adding MWM to supervised exercises when treating SIS patients showed a high percentage of improvement in VAS, the pain of Neer and Hawkins-Kennedy tests, and active ROM (flexion and scaption) (24,25,26,27,28) .…”

“…It has a range of 0 to 360 and is accurate to +/-1. The validity also reliability of the electro-goniometer for measuring shoulder joint movement was tested and well documented (12,13,14) .…”

Effect of Mobilization With Movement on the Glenohumeral Joint Positional Fault in Subacromial Impingement

“…In order to accomplish this work, individuals must repeatedly lift and carry objects overhead. To perform this work efficiently, complete shoulder range of motion (ROM) and strength of the rotator cuff muscles are important components [ 14 ]. Thus, SAI has a huge impact on socioeconomic status due to an individual's working ability limitation [ 15 ].…”