Impact of Mulligan and Maitland Techniques on Rotator Cuff Lesions
Condition: Rotator Cuff Tears
MeSH terms: Rotator Cuff Injuries
Study type: Interventional

Summary: 
      The shoulder joint in the human body has a broader range of motion and opening compared to
      other joints, resulting in a multitude of potential problems. The rotator cuff lesion is one
      such issue. The rotator cuff is found in the subacromial space of the shoulder and results
      from the compression of the subacromial bursa and the long head of the M.biceps muscle
      between the humerus and the coracoacromial arch.

      Upon reviewing the literature, therapeutic exercise and electrotherapy modalities are the
      most preferred and studied areas. Alongside these, we also observe the usage of Mulligan and
      Maitland techniques for the treatment of rotator cuff lesions.

      The Mulligan technique was developed by Brian Mulligan in 1980, who lent his name to it. Also
      known as mobilization with movement, this technique is often applied to the body's distal
      joints. The Maitland mobilization technique is used to treat the relevant joint with specific
      methods, particularly focusing on pain and stiffness in the joint. The technique's
      application is graded from 1 to 4. Grade 1 is a small oscillation created without loading
      throughout the joint movement. Grade 2 is performed with a slightly more oscillation from the
      beginning of the movement. Grades 1 and 2 aim to restrict the pain stimulus going to the
      central nervous system by stimulating the mechanoreceptor in the joint, thereby reducing the
      sensation of pain.

      Grade 3 is applied at a larger amplitude until a limitation is felt from the middle of the
      joint movement. Lastly, grade 4 is applied to the limited small amplitude until tissue
      resistance is felt. Grades 3 and 4 are used to alleviate joint stiffness by applying shorter
      oscillation stimuli to a shorter tissue. The results of the use of Mulligan and Maitland
      techniques have been demonstrated in different studies in the literature. However, as far as
      we know, no study in the literature compares these two techniques in individuals with rotator
      cuff lesions. Based on this gap in the literature, the purpose of this study is to
      investigate the effects of the Mulligan technique and the Maitland method on pain, range of
      joint motion, functionality, joint position sense, and quality of life in individuals with a
      rotator cuff problem.
    

Detailed description: 
      The aim of this study is to examine the effectiveness of the Mulligan and Maitland techniques
      on pain, range of joint motion, functionality, joint position sense, and quality of life in
      individuals diagnosed with rotator cuff lesions. Individuals diagnosed with a rotator cuff
      lesion and admitted to Medipol University Hospital will be included in the study.
      Participants will be randomly divided into three groups. A conventional treatment program
      will be applied to individuals in all three groups five days a week for three weeks. The
      first group will only receive conventional treatment. The second group will receive
      conventional treatment plus the Mulligan technique. The third group will receive conventional
      treatment plus the Maitland technique. The conventional treatment program will be applied to
      all participants included in the study, consisting of wand, codman, active and passive
      stretching exercises, and TENS. This program will be administered to all patients five days a
      week. Wand exercises will be applied in the directions of flexion, abduction, extension,
      internal and external rotation, and will consist of 10 repetitions. Codman exercises will be
      applied in the directions of flexion, abduction, and circular, and will also consist of 10
      repetitions. Active and passive stretching exercises will be applied in the directions of
      flexion, abduction, and external rotation, and will consist of 10 repetitions. TENS
      application will be administered for 20 minutes at 100Hz. All these exercises will be applied
      to the control, Mulligan, and Maitland groups.

      Mulligan Group: The mobilization with movement technique, a part of Mulligan applications,
      will be performed twice a week in the directions of flexion, abduction, and external
      rotation.

      Maitland Group: The Maitland application will be applied in the anterior-posterior,
      posterior-anterior, and caudal directions. The Maitland application will be administered at
      grades 2-3. Patients in this group will receive the application in five sets of 30 seconds,
      twice a week.
    

Intervention name(s): conventional exercise program; Mulligan application; Maitland application; TENS
Intervention type(s): Other; Other; Other; Device
Intervention description(s): The conventional treatment program will be applied to all participants included in the study, consisting of wand, codman, active and passive stretching exercises. This program will be administered to all patients five days a week. Wand exercises will be applied in the directions of flexion, abduction, extension, internal and external rotation, and will consist of 10 repetitions. Codman exercises will be applied in the directions of flexion, abduction, and circular, and will also consist of 10 repetitions. Active and passive stretching exercises will be applied in the directions of flexion, abduction, and external rotation, and will consist of 10 repetitions.; The mobilization with movement technique, a part of Mulligan applications, will be performed twice a week in the directions of flexion, abduction, and external rotation.; Maitland Group: The Maitland application will be applied in the anterior-posterior, posterior-anterior, and caudal directions. The Maitland application will be administered at grades 2-3. Patients in this group will receive the application in five sets of 30 seconds, twice a week.; TENS application will be administered for 20 minutes at 100Hz
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Rotator cuff; Mulligan mobilization; Maitland mobilization; Exercise