EBP

Datbases

- Pubmed

- PEDro

- Google Scholar

- PMC

- Cochrane Library

- Springerlink

- Sage

PubMed

("subacromial impingement syndrome" or "shoulder impingement" or "SAPS") and (("strengthening exercises" or "strength training") and ("mobilisation" or "mobilization"))

> 86 hits

Clinical Trial, Humans, Full Text, English

> 28 hits

FINAL ARTICLE:

The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome

Justification

Level of Evidence: 1-2

PRO: effect of mobilisation very clear

CON: old, not clear if improve of function results from strength training, low confidence interval

JOSP: latest evidence-based research, officially recognized journal

PEDro

1st search:

Therapy – Strength training

Problem – pain

Body part – upper arm, shoulder, shoulder girdle

Subdiscipline – musculoskeletal

Published since – 2013

Rating – 8+

Match terms with “AND”

>18 hits

2nd search:

changed "Therapy" to "stretching, mobilisation, manipulation, massage"

>24 hits

FINAL ARTICLE

The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SAPS.  

Justification

Level of evidence: RCT - 1

PRO: includes pain, results of pain reduction, muscle function and muscle strength

CON: PEMF (pulsed electromagnetic field) isn't part of the question

Archives PMR: original articles reporting on important trends and developments in physical medicine and rehabilitation

Sage

SEARCH TERMS:

(“SAPS” OR “subacromial pain syndrome”) and ((“strength training” or “exercise”) and and or (“mobilisation” or “mobilization”)

> 0 articles

"(“SAPS” OR “subacromial pain syndrome”) and (“strength training” or “exercise”)"

> 41 results,

> only free articles: 1

FINAL ARTICLE:

Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome

Justification

Level of Evidence: 2b

PRO: good study to see the outcome of strength training

CONS: small sample size, no mentioning of comparison to mobilisation

Clinical Rehabilitation: highly ranked, peer reviewed scholarly journal, acts as a forum

BOOK

Kisner & Colby

Justification

PRO: Recent publish and has a list of advantages and disadvantages for strength training and mobilisation

CON: not a lot of information specific to treating SIS or SAPS

BOOKS in general: They are officially approved before they were published, scientific work

EXPERT OPINION

Level of Evidence: 5

PT, Osteopath & Manual Therapist

- Ernst Jan Krol, practitioner since 1985

His comment:

- it is also important to look at scapulathoracic rhythm to identify any abnormalities

- after diagnosis of SAPS : mobilisation techniques

- after subacromial space is widened and pain decreased: strength training

Physiotherapist: Flurin Venzin

- Physiotherapist in Zürich since 2013 

His comment:

- if GH instability or weakness is the cause of SAPS: strengthening

- if joint restriction or other abnormalities is the cause of SAPS: mobilisation

GUIDELINE

Section of Guideline on BB

- Exercise therapy more effective than no treatment in reducing pain and improving function (Dickens and Williams 2005, Lombardi et al. 2008).

- Manual joint mobilizations have no added benefit to a program of active exercises in reducing pain and improving shoulder function (Brudvig et al. 2011)

Justification

Level of evidence: 1-2 for exercise therapy as treatment

PRO: Several researches together

CON: Mobilization is just additional, it is not mentioned as treatment alone

Acta Orthopaedica: original articles (basic research interest and clinical studies in orthopedics and related subdisciplines), manuscripts get checked