https://orcid.org/0000-0002-4928-4636
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ABSTRACT
Objective
To assess the effects of mobilization with movement (MWM) on pain, range of motion (ROM), and disability in the management of shoulder musculoskeletal disorders.
Methods
Six databases and Scopus, were searched for randomized control trials. The ROB 2.0 tool was used to determine risk-of-bias and GRADE used for quality of evidence. Meta-analyses were performed for the sub-category of frozen shoulder and shoulder pain with movement dysfunction to evaluate the effect of MWM in isolation or in addition to exercise therapy and/or electrotherapy when compared with other conservative interventions.
Results
Out of 25 studies, 21 were included in eight separate meta-analyses for pain, ROM, and disability in the two sub-categories. For frozen shoulder, the addition of MWM significantly improved pain (SMD −1.23, 95% CI −1.96, −0.51)), flexion ROM (MD −11.73, 95% CI −17.83, −5.64), abduction ROM (mean difference −13.14, 95% CI −19.42, −6.87), and disability (SMD −1.50, 95% CI (−2.30, −0.7). For shoulder pain with movement dysfunction, the addition of MWM significantly improved pain (SMD −1.07, 95% CI −1.87, −0.26), flexion ROM (mean difference −18.48, 95% CI- 32.43, −4.54), abduction ROM (MD −32.46, 95% CI – 69.76, 4.84), and disability (SMD −0.88, 95% CI −2.18, 0.43). The majority of studies were found to have a high risk of bias.
Discussion
MWM is associated with improved pain, mobility, and function in patients with a range of shoulder musculoskeletal disorders and the effects clinically meaningful. However, these findings need to be interpreted with caution due to the high levels of heterogeneity and risk of bias.
Level of Evidence
Treatment, level 1a.
Supplemental Material
Supplemental data for this article can be accessed here.
Disclosure statement
Kiran Satpute, Grant Mackay, Thomas Mitchell, and Toby Hall teach the Mulligan Concept on postgraduate physiotherapy courses, for which they receive a teaching fee.
Additional information
Notes on contributors
Kiran Satpute
holds postgraduate qualification in Musculoskeletal Physiotherapy. He is Associate Professor and Head of the Musculoskeletal Department at Smt. Kashibai Navale College of Physiotherapy, India. He is currently a PhD Scholar at Sancheti College of Physiotherapy, India.
Sue Reid
has been a titledmusculoskeletal physiotherapist for 30 years, and is a Certified Mulligan Practitioner and Honorary Member of the Mulligan Concept Teachers Association. She is currently a senior lecturer at the Australian Catholic University, prior to which she taught at the University of Newcastle in Australia for 14 years. Her clinical and research interests include the treatment of cervical spine dysfunction, headaches, tempero-manibular pain, concussion and dizziness. She has an extensive publication list, presented her research at several international conferences, and run numerous workshops on concussion management internationally.
Thomas Mitchell
is a wrist and hand specialist, First Contact Practitioner clinical supervisor and private practitioner in Sheffield UK.
Grant Mackay
is an Australian Physiotherapy Association titled Musculoskeletal Physiotherapist and works in clinical practice in Wollongong, Australia. He completed his Bachelor of Applied Science (Physiotherapy) with honours at the University of Sydney and his Master of Clinical Physiotherapy (Manipulative Therapy) at Curtin University. As a teaching member of the Mulligan Concept Teacher Association, Grant provides postgraduate training courses in the Mulligan Concept. Grant is a faculty staff member of Manual Concepts.
Toby Hall
is a Specialist Musculoskeletal Physiotherapist, Adjunct Associate Professor at Curtin University, and director of Manual Concepts. He graduated as a physiotherapist in the UK in 1985, completing an MSc in 1996 and a PhD in 2010. He has published more than 20 book chapters and more than 140 peer-reviewed articles. He has co-authored 3 books “Mobilisation with Movement, The Art and the Science” & The Mulligan Concept of Manual Therapy: Textbook of Techniques” in 1st & 2nd Edn. He regularly reviews for many journals, is on the international advisory panel of the Journal Musculoskeletal Science & Practice, and is an Associate Editor for the Journal of Manual and Manipulative Therapy.