A Comparative Analysis of Conventional Exercises, Maitland and Mulligan Mobilization Techniques for Managing Shoulder Impingement Syndrome: Randomized Controlled Trial

Background and purpose To compare the effectiveness of conventional exercises and spinal mobilization techniques for managing shoulder impingement syndrome. Since shoulder impingement syndrome (SIS) presents as anterolateral shoulder pain and is associated with the thoracic spine, demonstrating a clear correlation with the shoulder joint, research has indicated a connection between SIS and kyphosis. However, the literature suggests insufficient information regarding the optimal spinal mobilization technique for effectively managing SIS. Materials and Methods 45 male subjects were randomly assigned to 3 groups. Group A received traditional exercise management, Group B received the traditional exercises program in addition to ‘Maitland mobilization for the thoracic spine’, and Group C received the traditional exercises program in addition to Mulligan thoracic SNAGS. The outcome measures were active range of motion of the shoulder joint (abduction, flexion, and external rotation), Kyphotic angle, function and disability of the shoulder joint, and Pain level. Results All three groups improved each measured variable when compared pre and post-intervention (p=0.001). However, significant differences in measured variables in the post-intervention measurement were evident in four out of six measured variables. DASH scores and shoulder flexion range of motion showed no significant difference between the groups after the intervention (p > 0.05). On the other hand, an after-intervention effect was attributed to the group between A and C in pain, shoulder abduction ROM, shoulder external range of motion, and kyphosis angle (p = 0.037, p=0.001, p=0.002, p = 0.001). Conclusion Adding mobilization to the treatment protocol for SIS is more effective than traditional intervention, with Mulligan mobilization showing superior results over Maitland mobilization.