Why we use manual therapies with corrective exercises

The take home message

These results simply mean that if you have any sort of musculoskeletal pain syndrome or require the rehabilitation of an injury so called "corrective exercises" alone will be likely be inadequate. It is recommended that you consult a professional qualified to deal with joint issues. Please note that all such professionals also receive excellent training with respect to muscular issues as well, so are more than qualified to assess all.

Details of the trial

Summary

33 men and 22 women diagnosed with shoulder impingement syndrome were chosen. They were were randomly assigned either exercise alone or exercise and manual therapy. Each group received six sessions over three weeks.

Exercises

Exercises were conducted under the supervision of a physical therapist and were described as a "standardised strength and flexibility program". There were two passive stretches, plus six strengthening exercises described in the literature as being essential “core exercises” for shoulders.

Manual therapy

In trial of medication and simple therapies the intervention is easy to describe and quantify. However, for this trial experienced physiotherapists were basically told to assess the articular function and associated soft tissue issues of not only the glenohumeral (shoulder) joint but other related joints such as those of the cervical and thoracic spine. They were instructed to use their skills in manipulation and soft tissue therapies to correct what they found. This approach is not easy to quantify, but exactly what would happen if one consulted a quality clinician.

What was measured

Levels of pain were measured using visual analogue scales, which are usually having someone mark their level of pain on a scale of 1-10. Functional assessment was done using questionnaires covering a variety of general and specific activities.

The results

The results as measured by pain and function were clearly much superior for the group that received the manual therapy in addition to the exercises. It is best described by the following conclusion given by the authors.

"Manual therapy combined with supervised shoulder exercise is superior to supervised shoulder exercise alone for enhancing strength and function and reducing pain in patients with shoulder impingement syndrome. Our study also provides evidence that effective outcomes are obtainable after a relatively few physical therapy visits. It is important to recognise the functional interdependence of joints and soft tissues in the upper quarter when treating dysfunction of the shoulder."

Reference

Bang M Deyle G Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome J Orthop Sports Phys Ther. 2000 Mar;30(3):126-37.