Thesis (M.Sc.) - Cairo University - Faculty of Physical Therapy - Department of Musculoskeletal Disorders

Background: Subacromial impingement syndrome is considered the most prevalent cause of shoulder pain. Although Mulligan's technique may be useful in treating shoulder impingement, its significance in areas of (pain, range of motion and function) is still debated. Objective: To systematically review and summarize the best evidence on treating subacromial impingement syndrome using mobilization with movement. Methods: Databases Cochrane Library Web search, PEDro and PubMed were searched for RCTs published in English language from inception 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 randomized controlled trials with a total number of 358 adults with subacromial shoulder pain were included. They examined the effect of MWM combined with exercise compared to rotator cuff strengthening, ROM exercises, isometric strengthening, shoulder joint mobilization, and sham techniques. Meta-analysis was done comparing MWM against exercise and found out a significant difference in Visual Analog Scale favoring MWM and a non-significant difference in Shoulder Pain And Disability Index. Conclusion: Shoulder mobilization with movement combined with a therapist supervised exercise program has a better impact on pain, ROM, and functional limitations than exercise alone or sham in short term with similar improvement to exercise in the long term

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