Comparison of supervised exercise with and without manual physical therapyfor patients with shoulder impingement syndrome

Study Design: A prospective randomized clinical trial. Objective: To compare the effectiveness of 2 physical therapy treatment app roaches for impingement syndrome of the shoulder. Background: Manual physical therapy combined with exercise is a commonly ap plied but currently unproven clinical treatment for impingement syndrome of the shoulder. Methods and Measures: Thirty men and 22 women (age 43 years +/- 9.1) diagno sed with shoulder impingement syndrome were randomly assigned to 1 of 2 tre atment groups. The exercise group performed supervised flexibility and stre ngthening exercises. The manual therapy group performed the same program an d received manual physical therapy treatment. Both groups received the sele cted intervention 6 times over a 3-week period. The testers, who were blind ed to group assignment, measured strength, pain, and function before treatm ent and after 6 physical therapy visits. Strength was a composite score of isometric strength tests for internal rotation, external rotation, and abdu ction. Pain was a composite score of visual analog scale measures during re sisted break tests, active abduction, and functional activities. Function w as measured with a functional assessment questionnaire. The visual analog s cale used to measure pain with functional activities and the functional ass essment questionnaire were also measured 2 months after the initiation of t reatment. Results: Subjects in both groups experienced significant decreases in pain and increases in function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pretreatment mean (+/-SD) of 575.8 (+/-220.0) to a posttreatment mean of 174.4 (+/-183.1). In contrast, pain in the exercise group was reduced from a pretreatment mean of 557.1 ( +/-237.2) to a posttreatment mean of 360.6 (+/-272.3). Strength in the manu al therapy group improved significantly while strength in the exercise grou p did not. Conclusion: Manual physical therapy applied by experienced physical therapi sts combined with supervised exercise in a brief clinical trial is better t han exercise alone for increasing strength, decreasing pain, and improving function in patients with shoulder impingement syndrome.