Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design of the Study
2.2. Primary and Secondary Outcomes
- Flexion (aROM flex): individual standing in front of a square-shaped column. Shoulder flexion with elbow outstretched of the upper limb to be tested was required. The operator corrected any movement compensations (e.g., trunk movements).
- Abduction (aROM abd): individual standing upright and aligned with the same column with the side not being examined; shoulder abduction with elbow extended was required. The operator paid attention to any movement compensations.
- Internal and external rotation (aROM intra–aROM extra): subject prone on the couch, with pillow positioned under the chest and operator at the side to be tested. The humerus of the limb to be tested rested on the couch and the forearm in a vertical position outside with the elbow free to move; external rotation and internal rotation with flexed elbow were requested. The operator’s task was to check the possible movement compensation of the articular elements of the upper limb.
- Strength was measured through active muscle recruitment in flexion and abduction. The measurement was carried out by an isometric dynamometer (Sauter GmbH-FK 1K), fixed at the bottom of the wall bar by means of a fixed-length rope grasped by the hand of the limb to be tested, so as to allow a movement of less than 90° of elevation; the directions of movement considered were as follows:
- Flexion (s-Flex): The subject was positioned in an upright position facing and in contact with the back against the wall bar, requesting an elbow-stretched elevation. The operator corrected any movement compensations.
- Abduction (s-Abd): The subject was positioned with the contralateral shoulder facing the wall bar, requesting abduction elevation with the elbow outstretched, with the rope tied to the dynamometer anterior to the subject’s body. The operator checked that no movement compensations were performed.
2.3. Statistical Analysis and Intention to Treat
3. Results
4. Discussion
4.1. Results Discussion
4.2. Limits
- We included subjects with mild shoulder pain (at least 2 on the NRS scale); this threshold could not seriously affect mobility and functionality of the shoulder and the upper limb (the mean value of NRS at T0 in SG = 3.3 and in CG = 3.2).
- Due to the randomization criteria, the number of participants was quite different in the two groups: 47 in SG and 38 in CG. However, the two groups at T0 were statistically homogeneous in every outcome, except for the aROM flex.
- The probably most influential limit on the results of this study was the decision to treat only the CFs (centers of fusion) as elements of integration and connection between the segmentary motor activations, excluding the CCs (centers of coordination) that are widely used in daily clinical practice.
- The usual distance between two FM session is one week: we only performed two FM treatments 2 weeks apart. With more and closer FM treatments, we probably could obtain better statistical results.
- The limited follow-up period (30 days) does not allow us a proper long-term evaluation of the effects of the treatment performed.
- The aROM and strength assessment at T4 were probably conditioned by the second FM treatment carried out at the same time. The FM technique involves manual friction in the deep fascial tissues, often causing an annoying response and then potentially limiting the following active tests.
4.3. Indications for Clinical Practice
- A self-administered treatment with simple and easily repeatable exercises protocol, as well as a self-managed treatment diary, are elements that facilitate adherence to treatment by participants.
- The treatments in the study (active exercises, stretching exercises, and FM treatment) did not show any side effects and were well appreciated by all the subjects.
- Using both CCs and CFs in FM treatments represents a more comprehensive treatment choice with potentially better results.
- Using a weekly schedule for FM treatment and planning more than two FM treatments, as indicated in most clinical trials, could further improve clinical outcomes.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. The Daily Exercise Program
Stretching Exercises | ||
---|---|---|
Exercise 1 | Exercise 2 | Exercise 3 |
Upper trapezius stretch | Pectoralis minor stretch | Posterior shoulder stretch |
Strengthening Exercises | ||
Exercise 1 | Exercise 2 | Exercise 3 |
Shoulder external rotation | Shoulder extension targeting lower trapezius strengthening | Shoulder protraction targeting serratus anterior strengthening |
Appendix B. CFs Location
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Between Group Analysis | T0 | T0–T4 | T0–T5 | T4–T5 | ||||
---|---|---|---|---|---|---|---|---|
p-Value | 95% C.I. | p-Value | 95% C.I. | p-Value | 95% C.I. | p-Value | 95% C.I. | |
NRS | 0.653 | (-) | 0.407 | (-) | 0.107 | (-) | 0.115 | (-) |
s-Flex | 0.116 | −17.921 1.996 | 0.711 | −5.356 7.821 | 0.057 | −11.982 0.174 | 0.001 | −11.360 −2.914 |
s-Abd | 0.089 | −20.775 0.499 | 0.656 | −5.896 9.313 | 0.052 | −14.657 0.0759 | 0.001 | −14.274 −3.725 |
aROM Flex | 0.011 | −23.971 −3.176 | 0.879 | −8.727 10.181 | 0.628 | −8.698 14.331 | 0.444 | −3.3197 0.498 |
aROM Abd | 0.235 | −23.004 0.728 | 0.546 | −13.980 7.451 | 0.210 | −20.3694 0.537 | 0.170 | −11.330 2.0267 |
aROM Intra | 0.255 | −9.235 2.487 | 0.223 | −9.881 2.336 | 0.064 | −14.087 0.415 | 0.298 | −8.878 2.751 |
aROM Extra | 0.276 | −2.998 10.350 | 0.075 | −13.251 0.646 | 0.001 | −21.033 −5.287 | 0.024 | −12.804 −0.911 |
DASH | 0.972 | (-) | 0.333 | (-) | 0.1398 | (-) | 0.580 | (-) |
Constant Murley | 0.100 | (-) | 0.714 | (-) | 0.269 | (-) | 0.017 | (-) |
T0–T4 Analysis | NRS | s-Flex | s-Abd | aROM Flex | aROM Abd | aROM Intra | aROM Extra | DASH | Constant Murley | |
---|---|---|---|---|---|---|---|---|---|---|
Mean | CG | 2.2 | 11.8 | 15.8 | 22.7 | 29.4 | 12.6 | 10.0 | 13.7 | 13.6 |
Mean | SG | 2.7 | 10.6 | 14.1 | 22.0 | 32.7 | 16.4 | 16.3 | 17.6 | 12.4 |
MCID | 2 | 11.2 | 14.9 | 14 | 11 | 14 | 14 | 10.83 | 17 | |
MCID (n) | CG | 22 | 18 | 17 | 21 | 28 | 19 | 14 | 20 | 13 |
MCID (n) | SG | 33 | 24 | 27 | 34 | 40 | 30 | 25 | 27 | 12 |
MCID (%) | CG | 57.9 | 47.4 | 44.7 | 55.3 | 73.7 | 50.0 | 36.8 | 52.6 | 34.2 |
MCID (%) | SG | 70.2 | 51.1 | 57.4 | 72.3 | 85.1 | 63.8 | 53.2 | 57.4 | 25.5 |
T0-T5 Analysis | NRS | s-Flex | s-Abd | aROM Flex | aROM Abd | aROM Intra | aROM Extra | DASH | Constant Murley | |
---|---|---|---|---|---|---|---|---|---|---|
Mean | CG | 1.7 | 9.9 | 11.7 | 22.3 | 26.1 | 14.1 | 5.1 | 13.7 | 12.3 |
Mean | SG | 2.6 | 15.8 | 19.0 | 19.4 | 34.0 | 20.9 | 18.2 | 19.3 | 13.9 |
MCID | 2 | 13.1 | 15.8 | 14 | 11 | 14 | 14 | 10.83 | 17 | |
MCID (n) | CG | 21 | 13 | 10 | 19 | 23 | 20 | 11 | 21 | 14 |
MCID (n) | SG | 31 | 25 | 25 | 32 | 38 | 33 | 28 | 33 | 22 |
MCID (%) | CG | 55.3 | 34.2 | 26.3 | 50.0 | 60.5 | 52.6 | 28.9 | 55.3 | 36.8 |
MCID (%) | SG | 66.0 | 53.2 | 53.2 | 68.1 | 80.9 | 70.2 | 59.6 | 70.2 | 46.8 |
T4-T5 Analysis | NRS | s-Flex | s-Abd | aROM Flex | aROM Abd | aROM Intra | aROM Extra | DASH | Constant Murley | |
---|---|---|---|---|---|---|---|---|---|---|
Mean | CG | −0.5 | −2.0 | −4.1 | −0.4 | −3.3 | 1.4 | −4.9 | −0.1 | −1.3 |
Mean | SG | −0.1 | 5.2 | 4.9 | −2.5 | 1.4 | 4.5 | 2.0 | 1.7 | 1.6 |
MCID | 2 | 2.0 | 0.9 | 14 | 11 | 14 | 14 | 10.83 | 17 | |
MCID (n) | CG | 2 | 14 | 15 | 6 | 7 | 7 | 4 | 5 | 2 |
MCID (n) | SG | 3 | 28 | 31 | 2 | 9 | 15 | 10 | 9 | 1 |
MCID (%) | CG | 5.3 | 36.8 | 39.5 | 15.8 | 18.4 | 18.4 | 10.5 | 13.2 | 5.3 |
MCID (%) | SG | 6.4 | 59.6 | 66.0 | 4.3 | 19.1 | 31.9 | 21.3 | 19.1 | 2.1 |
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Bellotti, S.; Busato, M.; Cattaneo, C.; Branchini, M. Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease. Life 2023, 13, 1396. https://doi.org/10.3390/life13061396
Bellotti S, Busato M, Cattaneo C, Branchini M. Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease. Life. 2023; 13(6):1396. https://doi.org/10.3390/life13061396
Chicago/Turabian StyleBellotti, Silvia, Massimo Busato, Carla Cattaneo, and Mirco Branchini. 2023. "Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease" Life 13, no. 6: 1396. https://doi.org/10.3390/life13061396