PMT Versus IASTM in Subacromial Impingement Syndrome

Condition(s) studied

Investigational drug(s) / intervention(s)

Percussion massage therapy device: Percussion massage therapy will be administered using a handheld Hypervolt device (Hyperice, California, USA) at 33 Hz, corresponding to level 2 of the device. A flat-head attachment will be used to provide uniform contact with the treated tissues. The intervention will be applied to the deltoid, supraspinatus, infraspinatus, and teres minor muscles along their anatomical fibre orientation. Each muscle will be treated for three minutes using controlled longitudinal strokes applied alternately in proximal-to-distal and distal-to-proximal directions. The intervention will last 12 minutes per session and will be administered by the same licensed physiotherapist three times per week for four weeks. It will be provided in addition to the 30-minute conventional physiotherapy programme, resulting in a total session duration of 42 minutes.

Instrument-assisted soft tissue mobilization device: Instrument-assisted soft tissue mobilization will be administered to the deltoid, supraspinatus, infraspinatus, and teres minor muscles three times per week for four weeks. All applications will be performed by the same licensed physiotherapist. Standardized sweep and brush stroke techniques will be applied at an approximate treatment angle of 45° according to the anatomical fibre orientation of each muscle. For each muscle, 90 seconds of parallel strokes will be followed by 90 seconds of perpendicular strokes using controlled sweeping movements. The intervention will last three minutes per muscle and 12 minutes per session. It will be provided in addition to the 30-minute conventional physiotherapy programme, resulting in a total session duration of 42 minutes.

Conventional Physiotherapy: Participants will receive supervised conventional physiotherapy from a licensed physiotherapist five times weekly for four weeks. Each standard 30-minute session will include 20 minutes of TENS to the symptomatic shoulder at 100 Hz and 10 minutes of exercise. Exercises will comprise wand-assisted shoulder movements, Codman pendulum exercises, active and passive stretching, finger-ladder exercises, and elastic-band strengthening for flexion, abduction, extension, and internal and external rotation. Exercises will be performed for 10 repetitions per set, with resistance progressed according to pain, function, and tolerance. To match treatment duration and therapist contact, the control group will perform an additional standardized 12-minute exercise block during three sessions weekly, including one extra set of range-of-motion and resistance exercises. Sessions will therefore last 42 minutes on three days and 30 minutes on two days weekly.

Study summary

This assessor-blinded, three-arm, parallel-group randomized controlled trial will investigate the additional effects of percussion massage therapy and instrument-assisted soft tissue mobilization in individuals with subacromial impingement syndrome. Forty-eight participants aged 40-60 years with clinically and magnetic resonance imaging-confirmed subacromial impingement syndrome will be randomly allocated in a 1:1:1 ratio to conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.

All groups received a standardized four-week conventional physiotherapy programme. Participants in the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received their respective interventions three times per week for four weeks. Outcomes were evaluated at baseline and immediately after the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes were shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.

Eligibility

Primary outcome measure(s)

• Change in Shoulder Joint Position Sense Error — Baseline and immediately after the 4-week intervention
  Shoulder joint position sense will be assessed using a digital goniometer at target positions of 60° of shoulder flexion and 60° of shoulder abduction. The affected shoulder will be passively positioned at the target angle, and the participant will be allowed up to 10 seconds to memorize the position. The arm will then be returned to the neutral position, and the participant will be asked to actively reproduce the target position with their eyes closed. The absolute angular difference between the target position and the reproduced position will be calculated in degrees. Three trials will be conducted for flexion and three trials for abduction, and the mean absolute error for each direction will be used in the analysis. Lower values will indicate greater joint position sense accuracy.

Trial sites (1)

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