Effects of Manual Therapy on Shoulder Function

NCT04513535 | Completed

• 1 other identifier: PRO20010001
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to directly compare the effects of four distinct interventions commonly used in the treatment of shoulder pathology on shoulder range of motion (ROM) and strength in asymptomatic shoulders:

• grade III oscillatory anterior-posterior glenohumeral joint mobilizations
• an internal rotation (IR) "sleeper" stretch
• supine upper-thoracic manipulation
• cervical spine manipulation

Conditions

Musculoskeletal Manipulations; Shoulder; Range of Motion; Muscle Strength; Surface Electromyography

Outcome Measures

Primary Outcomes (4)

• Change in shoulder ER strength

  pre-test post-test strength test of the infraspinatus with hand held dynamometer

  immediate pre-post intervention

• Change in shoulder IR ROM

  change pre-post test IR ROM at 90 degrees ABD

  immediate pre-post intervention

• change in posterior shoulder mobility

  change in pre-post test posterior shoulder mobility assessed in horizontal adduction

  immediate pre-post intervention

• change in infraspinatus EMG activity

  change in pre-post test EMG peak and mean root squared activity

  immediate pre-post intervention

Study Arms (6)

manual therapy combination 1

EXPERIMENTAL

Cervical manipulation, Thoracic manipulation

Other: Thoracic Manipulation; Other: Cervical Manipulation

manual therapy combination 2

EXPERIMENTAL

Cervical manipulation, glenohumeral mobilization

Other: Cervical Manipulation; Other: glenohumeral posterior glide mobilization

manual therapy combination 3

EXPERIMENTAL

cervical manipulation, sleeper stretch

Other: Cervical Manipulation; Other: Sleeper stretch

manual therapy combination 4

EXPERIMENTAL

thoracic manipulation, glenohumeral mobilization

Other: Thoracic Manipulation; Other: glenohumeral posterior glide mobilization

manual therapy combination 5

EXPERIMENTAL

thoracic manipulation, sleeper stretch

Other: Thoracic Manipulation; Other: Sleeper stretch

manual therapy combination 6

EXPERIMENTAL

glenohumeral mobilization, sleeper stretch

Other: glenohumeral posterior glide mobilization; Other: Sleeper stretch

Interventions

Thoracic Manipulation OTHER

A supine thoracic manipulation will be utilized. Participants will be lying supine on the plinth with their arms crossed over their chest, making sure the forearms are not crossed. An experienced clinician will place their hand on the inferior segment (T4); the superior segment (T3) will be placed in the midrange of thoracic flexion and extension. The clinician will apply a high velocity, end range, anterior to posterior thrust by using their body weight to deliver the thrust through the participants crossed elbows, thus creating a bilateral gapping of the facet joints. If a cavitation is achieved after the first thrust, the thoracic manipulation intervention is complete. If not, one more attempt will be made to achieve a cavitation. Regardless of if there was a cavitation or not, after the second attempt the intervention is complete.

manual therapy combination 1; manual therapy combination 4; manual therapy combination 5

Cervical Manipulation OTHER

Participants will be lying supine on the plinth on the table. A high velocity low amplitude manipulation will be performed to the cervical spine by an experienced clinician.The clinician will place the right proximal phalanx of the index finger over the posterolateral aspect of the articular pillar at the right C4/C5 segment to maximally influence the C5 myotomal distribution. The clinician's left hand will be cradling the participants head. The participant will be brought into midrange flexion-extension, ipsilateral side bend, and contralateral rotation of C4/5. Once a firm end feel is felt the manipulation will be administered into left rotation in an arc toward the left eye. If a cavitation is achieved after the first thrust, the intervention is complete. If not, one more attempt will be made to achieve a cavitation;after the second attempt the intervention is complete.

manual therapy combination 1; manual therapy combination 2; manual therapy combination 3

glenohumeral posterior glide mobilization OTHER

Participants will be instructed to lay supine on the plinth and a plastic orthopedic wedge will be placed under their scapula for stabilization on the side that is receiving the mobilization. The experienced clinician will stand on the same side being mobilized and held the participant's arm proximal to the medial and lateral humeral epicondyles. The clinician will hold the participant's arm in the scapular plane, approximately 55 degrees of abduction and slight ER with a grade one long axis distraction applied and sustained throughout the entire mobilization. A grade three oscillatory mobilization will be applied for three sets of 30 seconds with a 30 second rest in between.

manual therapy combination 2; manual therapy combination 4; manual therapy combination 6

Sleeper stretch OTHER

Participants will be positioned in a side lying position with the arm to be stretched on the table. The arm to be tested will then be positioned at a 90-90 shoulder abduction and elbow flexion position. A support will be positioned behind the patient to ensure there is no compensatory trunk movement during the stretch, and an examiner verified the arm is in a 90-90 position. A sleeper stretch will be subsequently completed, in which the participant will internally rotate the arm to stretch the posterior shoulder musculature. Three, thirty second stretches will be completed

manual therapy combination 3; manual therapy combination 5; manual therapy combination 6

Eligibility Criteria

• Age: 18 Years - 55 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Participants will be included in this study if they:
• are between the ages of 18 and 55
• have no history of shoulder, neck, or upper back dysfunction.

You may not qualify if:

• Individuals will be excluded if they report having any of the following conditions:
• shoulder, neck, or upper back pain;
• prior shoulder, neck or upper back surgery;
• previous injury to shoulder, neck, or thoracic area;
• active inflammatory disease process in treatment area;
• osteoporosis;
• signs and symptoms of a nerve root pathology/radiculopathy (dermatomal sensory changes, myotomal weakness, reflex changes);
• upper motor neuron lesions/spinal cord pathology;
• local infection;
• active or history of cancer;
• long term corticosteroid use;
• systemically unwell;
• systemic hyperlaxity;
• known connective tissue disease;
• known abnormalities of the spine;

Sponsors & Collaborators

• University of Hartford: lead

Study Sites (1)

University of Hartford

West Hartford, Connecticut, 06117, United States

Location

MeSH Terms

Interventions

Manipulation, Spinal

Intervention Hierarchy (Ancestors)

Musculoskeletal Manipulations; Physical Therapy Modalities; Therapeutics; Rehabilitation

Study Officials

• Brian Swanson, PT, DSc

  University of Hartford

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: outcomes assessor blinded to group allocations
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: modified crossover, each group will experience 2/4 interventions

Study Record Dates

• First Submitted: August 11, 2020
• First Posted: August 14, 2020
• Study Start: February 7, 2020
• Primary Completion: November 1, 2020
• Study Completion: November 1, 2020
• Last Updated: February 23, 2021

Record last verified: 2021-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)