Effect of Mulligan Technique on Subacromial Impingement Syndrome: A Systematic Review

Abstract

Background: Subacromial impingement syndrome (SIS) is considered the most prevailing cause of shoulder pain. Although Mulligan's technique may be useful in treating shoulder impingement, its significance in areas of range of movement (ROM), pain, and function is still debated.
Objective: To systematically review and summarize the best evidence on treating subacromial impingement syndrome using mobilization with movement.
Patients and Methods: Databases Cochrane Library Web search, PEDro and PubMed were searched for RCTs published in English language from inception to September 2019, updated later to 7th of July 2021. Reference lists of relevant publications were also screened. Two reviewers separately identified relevant papers based on the inclusion criteria. The identified papers by both authors were obtained in full text. To evaluate methodological quality and risk of bias, the Cochrane risk of bias tool was used. We used the random-effects model in all analyses for meta-analyses.
Results: A total of 11 RCTs with a total number of 358 adults with subacromial shoulder pain were included. They examined the effect of mobilization with movement (MWM) combined with exercise with or without taping against rotator cuff strengthening, ROM exercises, isometric strengthening, shoulder joint mobilization, and sham techniques. Meta-analysis was done comparing MWM against exercise and found a significant difference in VAS and a non-significant difference in SPADI.
Conclusion: Shoulder mobilization with movement combined with a supervised exercise program (ROM, and functional limitations) has a better impact on pain than exercise alone or sham in short-term with similar improvement to exercise in the long-term.