Investigating the effects of mobilization with movement and exercise on pain modulation processes in shoulder pain – a single cohort pilot study with short-term follow up

ABSTRACT

Objective

To explore the association between manual therapy and exercise and pain modulation and clinical characteristics in people with musculoskeletal shoulder pain.

Methods

This is a prospective, longitudinal, single cohort pilot study. People with shoulder pain for longer than 6 weeks underwent 4 weeks of glenohumeral mobilization with movement and shoulder exercises. Measures of pain modulation, shoulder pain, disability, range of motion and psychosocial factors were assessed at baseline and immediately after the 4-week period of treatment. Treatment effectiveness was assessed through parametric, non-parametric and multilevel modeling statistics.

Results

Twenty-three individuals participatedwith no loss to follow-up. Significant and meaningful improvements in shoulder pain (NRS mean change 1.6/10, 95% CI 0.4 to 2.7), disability (SPADI mean change 20.5/100, 95% CI 13.1 to 27.9) and range of motion (mean change 33°, 95% CI 23 to 43°) were observed following treatment. Statistical but non-clinically meaningful changes were observed in temporal summation of pain (mean change 0.3/10, 95% CI 0.1 to 0.4) and anxiety (mean change 0.86/21, 95% CI 0.18 to 1.55). Significant reductions were observed in temporal summation of pain (mean change 0.3/10, 95% CI 0.1 to 0.4) and anxiety (mean change 0.86/21, 95% CI 0.18 to 1.55), however these were not considered clinically important. No association was found between clinical characteristics and sensory measures. No association was found between clinical characteristics and sensory measures.

Conclusion

Glenohumeral mobilization with movement and exercise did not improve pain modulation, despite improvements in pain, function and range of motion, in people with shoulder pain.

KEYWORDS:

• Pain perception
• pain measurement
• shoulder pain
• musculoskeletal manipulations
• exercise therapy

Acknowledgments

The first author received a travel grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (Brazil) to perform this study at Griffith University, Queensland, Australia. Thank you to Professor Paula Rezende Camargo who was the supervisor of the first author during her PhD studies. The authors would also like to thank Carlos Eduardo Pinfildi for help with data collection and study participants for volunteering for this study.

Disclosure statement

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

Data sharing statement

Individual deidentified participant data that underlie the results reported in this article will be available immediately following publication for up to 5 years. Data will be available to researchers who provide a methodologically sound proposal directed to corresponding author. Available documents include study protocol, analysis plan, informed consent and any result not clearly described in the report.

Additional information

Funding

The study was approved by the Griffith University Human Research Ethics Committee [AHS/65/14/HREC] and registered at anzctr.org.au [ACTRN12615000351516] with Universal Trial Number (UTN) U1111-1168-8622; Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP 2014/06004–0, Brasil]; fundação de amparo à pesquisa do estado de são paulo [2013/07120–1].

Notes on contributors

Melina N Haik

Dr. Haik is an Adjunct Research Professor at the Federal University of São Carlos and a practising Specialist Musculoskeletal Physiotherapist with 15 years of clinical experience in musculoskeletal pain. Her research and clinical interests include applying a biopsychosocial model to the prevention and management of shoulder pain, manual therapy and pain processes.

Kerrie Evans

Dr. Evans is a part-time Senior Research Fellow at The University of Sydney and a practising Specialist Musculoskeletal Physiotherapist. She has >25 years’ of clinical experience and leads the professional development and research for Healthia Limited, a large publicly listed allied health organisation. Her research and clinical interests are prevention and management of spinal pain, pain and models of care in primary healthcare settings.

Ashley Smith

Dr. Smith is an Assistant Research Professor at the University of Calgary and practising Clinical Specialist in Musculoskeletal Physiotherapy with over 25 years of experience. His research studies focus on the clinical features of whiplash-associated disorders and the role of orthobiologics in the management of chronic musculoskeletal pain.

Leanne Bisset

Dr Bisset is an Associate Professor in Physiotherapy at Griffith University and an experienced Musculoskeletal Physiotherapist in Australia. She is an active researcher in upper limb musculoskeletal health.