Overview
This assessor-blinded, three-arm, parallel-group randomized controlled trial will investigate the additional effects of percussion massage therapy and instrument-assisted soft tissue mobilization in individuals with subacromial impingement syndrome. Forty-eight participants aged 40-60 years with clinically and magnetic resonance imaging-confirmed subacromial impingement syndrome will be randomly allocated in a 1:1:1 ratio to conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.
All groups received a standardized four-week conventional physiotherapy programme. Participants in the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received their respective interventions three times per week for four weeks. Outcomes were evaluated at baseline and immediately after the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes were shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.
Description
Subacromial impingement syndrome is commonly associated with shoulder pain, limitations in range of motion, functional disability, and impaired sensorimotor control. Exercise-based rehabilitation is considered a primary component of conservative management. Percussion massage therapy and instrument-assisted soft tissue mobilization are frequently used as adjunct soft-tissue interventions; however, comparative evidence regarding their additional effects in individuals with subacromial impingement syndrome remains limited.
This study will be conducted as a parallel-group, assessor-blinded randomized controlled trial with a 1:1:1 allocation ratio. Forty-eight eligible participants will be randomly allocated to one of three groups: conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.
The randomization sequence will be computer-generated using Randomizer.org by an independent researcher who will not be involved in participant recruitment, intervention delivery, or outcome assessment. Because of the nature of the interventions, blinding of participants and treating physiotherapists will not be possible. Outcome assessments will be conducted by an independent physiotherapist who will be blinded to group allocation. Statistical analyses will be performed by a biostatistician who will be blinded to the coded group assignments.
All participants will receive a standardized conventional physiotherapy programme for four weeks. Participants assigned to the percussion massage therapy and instrument-assisted soft tissue mobilization groups will additionally receive the corresponding soft-tissue intervention three times per week for four weeks.
Outcome assessments will be performed at baseline and immediately after completion of the four-week intervention. The primary outcome will be shoulder joint position sense during flexion and abduction. Secondary outcomes will include shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.
Eligibility
Inclusion Criteria:
- Men or women aged 40 to 60 years.
- Diagnosis of subacromial impingement syndrome confirmed by clinical examination and -magnetic resonance imaging.
- Positive Neer test.
- Positive Hawkins-Kennedy test.
- Positive painful arc test.
- Shoulder symptoms persisting for at least one month.
- Ability and willingness to participate in the assessment and intervention programme.
- Provision of written informed consent.
Exclusion Criteria:
- Previous surgery involving the affected upper extremity.
- Inflammatory joint disease.
- Shoulder osteoarthritis.
- Rheumatic disease.
- Malignant or benign tumour affecting the shoulder region or upper extremity.
- Open wound or active infection in the shoulder region.
- Inability to tolerate vibration-based therapy.
- Inability to comply with the study protocol or intervention programme.
