Investigation of the Effect of Mulligan Mobilization and Respiratory Exercises in Individuals With Rotator Cuff Syndrome

Sponsor

Istanbul Medipol University Hospital (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT05584345

Collaborator

(none)

Enrollment

Location

Arms

3.2

Anticipated Duration (Months)

14.3

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

As it causes pain and disability in individuals with rotator cuff lesions, which is one of the most common causes of shoulder pain, it affects performance in activities of daily living. Shoulder pain significantly affects the quality of life of individuals. The aim of conventional treatment in Rotator Cuff injuries is to reduce the inflammation in the area and to enable the shoulder to perform its normal functions. Conventional treatment is to restore muscle balance in the shoulder area. Muscle balance is achieved by strengthening the teres minor, infraspinatus, and subscapularis, which are also the humeral head depressors, and by strengthening the serratus anterior, levator scapula. For strengthening, the shoulder must have a full range of motion. In our study, stretching exercises, cold pack, Ultrasound, TENS, wand, and Codman exercises, which are classical physiotherapy methods, will be applied to all three groups. There are also studies in the literature investigating the effects of traditional physiotherapy methods on individuals with shoulder Rotator Cuff syndrome. Over the past 20 years, the Mulligan mobilization approach in manual therapy has acquired popularity on a global scale. Mulligan developed his own idea in 1985 and used it to achieve his first success. Continual gliding and continuous active movement are part of the concept. Natural apophyseal glide, continuous natural apophyseal glide, and motion mobilization (MWM) procedures are all included in the Mulligan mobilization technique.The benefits of breathing exercises on pain, shoulder joint range of motion, and balance have all been researched in the literature. Increased diaphragm activity also guarantees that posture and body positions are maintained healthily. Diaphragm activity generally alters how an individual perceives pain. Diaphragmatic breathing is a therapeutic approach for musculoskeletal disorders.

Condition or Disease	Intervention/Treatment	Phase
Rotator Cuff Syndrome	Other: Conventional Treatment Other: Mulligan Mobilization Other: Respiratory Exercises	N/A

Detailed Description

Mulligan mobilization and breathing techniques have been demonstrated to reduce shoulder pain and increase ROM at the literature. However, no study has been found on the effectiveness of Mulligan mobilization and breathing exercises applied in addition to conventional physiotherapy in individuals with Rotator Cuff syndrome.

Based on all of this knowledge, it was designed for this study to examine the efficacy of Mulligan mobilization and breathing exercises used in combination with traditional physiotherapy in patients with Rotator Cuff syndrome.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

45 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Single (Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

Investigation of the Effect of Mulligan Mobilization and Respiratory Exercises in Individuals With Rotator Cuff Syndrome

Anticipated Study Start Date :

Oct 30, 2022

Anticipated Primary Completion Date :

Jan 6, 2023

Anticipated Study Completion Date :

Feb 3, 2023

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: CONTROL Traditional physiotherapy applications will be applied.	Other: Conventional Treatment Cold pack, ultrasound, TENS, finger ladder, Codman, shoulder wheel, and Wand exercises, as well as stretching and capsule exercises, will be used in addition to conventional physiotherapy. Exercises with a wand will be performed 10 times in each direction. There will be 30 repetitions in each direction of the Codman exercises. 5 days a week, for a total of 30 sessions, the afflicted shoulder will get 6 minutes of daily US treatment, with complete contact to the shoulder area and at a right angle. All patients will receive manual stretching in the shoulder flexion, abduction, extension, external rotation, and internal rotation directions. The physiotherapist will perform these stretches 5 times in each direction, pausing for 20 seconds at the conclusion of each repeat. TENS will be applied for 20 minutes. In addition, a 15-minute cold pack application will be made to the shoulder region. The application of theraband strengthening exercises will depend on the patients' state.
Experimental: MULLIGAN MOBILIZATION GROUP In addition to traditional physiotherapy applications, mulligan mobilization wiil be applied.	Other: Conventional Treatment Cold pack, ultrasound, TENS, finger ladder, Codman, shoulder wheel, and Wand exercises, as well as stretching and capsule exercises, will be used in addition to conventional physiotherapy. Exercises with a wand will be performed 10 times in each direction. There will be 30 repetitions in each direction of the Codman exercises. 5 days a week, for a total of 30 sessions, the afflicted shoulder will get 6 minutes of daily US treatment, with complete contact to the shoulder area and at a right angle. All patients will receive manual stretching in the shoulder flexion, abduction, extension, external rotation, and internal rotation directions. The physiotherapist will perform these stretches 5 times in each direction, pausing for 20 seconds at the conclusion of each repeat. TENS will be applied for 20 minutes. In addition, a 15-minute cold pack application will be made to the shoulder region. The application of theraband strengthening exercises will depend on the patients' state. Other: Mulligan Mobilization MWM technique, one of the Mulligan mobilization techniques, will be applied 2 days a week in the directions of flexion, abduction, external rotation and internal rotation. MWM technique will be applied as 3 sets of 10 repetitions.
Experimental: MULLIGAN MOBILIZATION AND RESPIRATORY EXERCISES GROUP In addition to traditional physiotherapy and mulligan mobilization applications, respiratory exercises wiil be applied.	Other: Conventional Treatment Cold pack, ultrasound, TENS, finger ladder, Codman, shoulder wheel, and Wand exercises, as well as stretching and capsule exercises, will be used in addition to conventional physiotherapy. Exercises with a wand will be performed 10 times in each direction. There will be 30 repetitions in each direction of the Codman exercises. 5 days a week, for a total of 30 sessions, the afflicted shoulder will get 6 minutes of daily US treatment, with complete contact to the shoulder area and at a right angle. All patients will receive manual stretching in the shoulder flexion, abduction, extension, external rotation, and internal rotation directions. The physiotherapist will perform these stretches 5 times in each direction, pausing for 20 seconds at the conclusion of each repeat. TENS will be applied for 20 minutes. In addition, a 15-minute cold pack application will be made to the shoulder region. The application of theraband strengthening exercises will depend on the patients' state. Other: Mulligan Mobilization MWM technique, one of the Mulligan mobilization techniques, will be applied 2 days a week in the directions of flexion, abduction, external rotation and internal rotation. MWM technique will be applied as 3 sets of 10 repetitions. Other: Respiratory Exercises Diaphragmatic breathing and thoracic expansion breathing exercises will be applied 5 days a week.

Arm

Intervention/Treatment

Active Comparator: CONTROL

Traditional physiotherapy applications will be applied.

Other: Conventional Treatment

Cold pack, ultrasound, TENS, finger ladder, Codman, shoulder wheel, and Wand exercises, as well as stretching and capsule exercises, will be used in addition to conventional physiotherapy. Exercises with a wand will be performed 10 times in each direction. There will be 30 repetitions in each direction of the Codman exercises. 5 days a week, for a total of 30 sessions, the afflicted shoulder will get 6 minutes of daily US treatment, with complete contact to the shoulder area and at a right angle. All patients will receive manual stretching in the shoulder flexion, abduction, extension, external rotation, and internal rotation directions. The physiotherapist will perform these stretches 5 times in each direction, pausing for 20 seconds at the conclusion of each repeat. TENS will be applied for 20 minutes. In addition, a 15-minute cold pack application will be made to the shoulder region. The application of theraband strengthening exercises will depend on the patients' state.

Experimental: MULLIGAN MOBILIZATION GROUP

In addition to traditional physiotherapy applications, mulligan mobilization wiil be applied.

Other: Conventional Treatment

Other: Mulligan Mobilization

MWM technique, one of the Mulligan mobilization techniques, will be applied 2 days a week in the directions of flexion, abduction, external rotation and internal rotation. MWM technique will be applied as 3 sets of 10 repetitions.

Experimental: MULLIGAN MOBILIZATION AND RESPIRATORY EXERCISES GROUP

In addition to traditional physiotherapy and mulligan mobilization applications, respiratory exercises wiil be applied.

Other: Conventional Treatment

Other: Mulligan Mobilization

Other: Respiratory Exercises

Diaphragmatic breathing and thoracic expansion breathing exercises will be applied 5 days a week.

Outcome Measures

Primary Outcome Measures

Numerical Rating Scale (NRS) [from pre-interventional time to post-interventional about 1st week]
NRS is widely used in research and clinical settings to represent pain intensity. NRS is stated as the absence of pain as 0 and the worst possible pain as 10.

Secondary Outcome Measures

Goniometric Measurement [from pre-interventional time to post-interventional about 1st week]
In our study, the degrees of flexion, extension, abduction, internal rotation, and external rotation of the affected shoulder will be measured by means of a universal goniometer. Flexion and abduction 0-180 degrees, extension 45 degrees, internal and external rotation 0-90 degrees will be taken as reference.
The Disabilities of the Arm, Shoulder and Hand (DASH) [from pre-interventional time to post-interventional about 1st week]
Introduced by the American Academy of Orthopedic Surgeons and other organizations, DASH is a scale that evaluates physical limitations and function in upper extremity problems. The DASH questionnaire includes three sub-parameters. The first part contains 30 questions; 21 questions measure the patient's difficulty in daily life functions, 5 questions measure symptoms, and the other 4 questions measure social function, work, sleep, and self-confidence. A 4-question section (optionally answered Business Model (DASHFS)) measures the patient's disability in working life.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 65 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Restricted shoulder joint range of motion
Having Rotator Cuff Syndrome
Not having had any shoulder surgery
Being between the ages of 18 - 65

Exclusion Criteria:

Major trauma to the shoulder
Anatomical deformities and skeletal system fractures
Diagnosed orthopedic or rheumatological diseases
Being included in a physiotherapy program in the last 6 months
Having a cardiac pacemaker
Presence of active infection
Myocardial infarction in the last 6 months
Participants who have any illness that prevents them from doing the exercises will be excluded from the study.