Mulligan Mobilization vs Transverse Friction Massage in Rotator Cuff Syndrome
Condition: Rotator Cuff Syndrome
MeSH terms: Syndrome; Rotator Cuff Injuries
Study type: Interventional

Summary: 
      The aim of this research is to determine the Effects of Mulligan Mobilization and Transverse
      Friction Massage in Rotator Cuff Syndrome. Randomized clinical trials will be done at
      Northwest General Hospital, Peshawar. The sample size is 42. The subjects were divided in two
      groups, with 21 subjects in Group A and 21 in Group B. Study duration was of 6 months.
      Sampling technique applied was Non probability Purposive Sampling technique. Both males and
      females of aged 30-70 years with rotator cuff syndrome from grade (0-3) were included. Tools
      used in the study are Visual Analogue Scale (VAS), Goniometer, and DASH (Disabilities of the
      Arm, Shoulder and Hand) questionnaire. Data was analyzed through SPSS 23.
    

Detailed description: 
      The rotator cuff syndrome is developed in the subacromial area by compression between the
      humerus and the coracoacromial arc of the long head of the subacromial bursa and the biceps
      tendon. The diagnosis of rotator cuff tendonitis and Bursitis is made on the basis of special
      tests and Examination. The rotator cuff tendons undergo degenerative alterations, the tendons
      between the humeral head and the coracoacromial arch are compressed and ischemia caused by
      impingement or elevated intramuscular pressure is all aspects of the physiopathology of RCS.

      Highly exposed workers have frequently had RCS associated with biomechanical, psychological,
      and organizational aspects examined; this could affect generalizations to the entire working
      population who are exposed to varying degrees of work-related shoulder restrictions. The
      relationship between work structure and the risk of shoulder illnesses has been rarely
      investigated. Although various individual factors can raise the incidence of shoulder
      discomfort and RCS, biomechanical factors are significantly linked to both conditions (e.g.,
      age).

      Neer defined the syndrome as impingement of the rotator cuff tendons against the
      coracoacromial ligament, the anterior edge and undersurface of the anterior part of the
      acromion, and, often, the acromioclavicular joint. There is consensus that risk factors for
      shoulder MSDs are upper arm elevation and repeated or prolonged overhead activities in
      combination with other biomechanical variables (e.g., repetition, force). There is less proof
      that excessive repetition or rigid shoulder positions are separate risk factors.

      The main focus in Rotator Cuff syndrome management is on promoting self-management, reducing
      pain, optimize function, and modifying the disease process and its effects. The primary
      treatment for Rotator Cuff syndrome conservatively is physiotherapy which includes strength
      training, modalities, resistance training and Kinesiotaping. Resistance exercise can reduce
      Shoulder pain severity and strength in participants with symptomatic Shoulder RCS. Exercise
      is suggested as the first-line intervention of choice with comparable outcomes but at a lower
      cost and with fewer associated hazards than surgical therapy in recent randomized controlled
      studies and systematic reviews. Despite this, there is little evidence that explains what an
      effective exercise programmed looks like in terms of the kind of exercise, the number of sets
      and repetitions, tolerable pain levels, duration, and environment.

      Mulligan's mobilization with movement (MWM) is a joint mobilization treatment in which the
      patient actively engages in the uncomfortable action while receiving a manual accessory glide
      to one of the joint surfaces. Recent research found that in asymptomatic people applying MWM
      with a postero-lateral glide resulted in less muscular activity in the shoulder muscles . In
      accordance with Cyriax, Transverse friction massage leads in traumatic hyperemia, which
      boosts blood flow and lessens discomfort. It also stimulates mechanoreceptors and enhances
      tissue perfusion.
    

Intervention name(s): Mulligan Mobilzation; Trasverse Friction Massage
Intervention type(s): Other; Other
Intervention description(s): Participants were instructed that MWM, including shoulder movement, must be pain-free and should be immediately stopped if any pain is experienced during the treatment.
The single session of MWM technique was last around 20 minutes, in 3 sets of 10 repetitions with a rest interval of 30 seconds between each sets.; Deep friction massage was given to rotator cuff tendon with the tip of index finger, which is reinforced by middle finger.
It was given in transverse direction for 10 - 12 minutes. Transverse friction massage was Given twice a week with the gap of days for the first 3 week and then the repetition is increased to 3 to 4 times a week for the rest of duration.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Mulligan mobilization; Transverse Friction Massage; Rotator cuff syndrome