Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial

ABSTRACT

Purpose

To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome.

Methods

Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention).

Results

After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05).

Conclusion

Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.

KEYWORDS:

• Sub-acromial pain
• impingement syndrome
• thoracic spine SNAGS
• size of sub-acromial space

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research received no funding from the government, the private sector, or non-profit organizations.

Notes on contributors

Shimaa T. Abu EL Kasem

Shimaa T. Abu EL Kasem, Assistant Professor of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University.

Fatma Alzahraa A. Alaa

Fatma Alzahraa A. Alaa, Master’s Degree, Basic Science Department, Faculty of Physical Therapy, 6th October University.

Neveen A. Abd EL-Raoof

Neveen A. Abd EL-Raoof, Professor of Physical Therapy, Basic Science Department, Faculty of Physical Therapy Cairo University.

Alshaymaa S. Abd-Elazeim

Alshaymaa S. Abd-Elazeim, Lecturer, Basic Science Department, Faculty of Physical Therapy, Cairo University.