Inclusion of Mobilisation With Movement to an Exercise Programme in Rotator Cuff Related Pain
Inclusion of Mobilisation With Movement to an Exercise Programme in Rotator Cuff Related Pain
Rotator cuff related pain is considered the main source of musculoskeletal shoulder pain that
 affects function and produces pain on movement. Amongst the existing physiotherapeutic
 management approaches, exercise therapy has been recognized as the first line approach. The
 use of manual therapy in the management of this condition has been debated and studies have
 shown contradictory results. A specific manual therapy approach, mobilisation with movement
 (MWM), seems promising in this population as it aims to improve pain-free range of motion and
 includes active engagement of the participant.
Rotator cuff related pain is a term that includes a diversity of shoulder conditions known
 as: subacromial impingement syndrome, rotator cuff tendinitis/tendinopathy, rotator cuff
 tear, bursitis. The use of a broader term is useful as the diagnostic accuracy of special
 orthopaedic tests have been widely criticised and are unable to identify pathognomonic
 sources of symptoms in people presenting with shoulder pain. Additionally, even though
 diagnostic imaging is capable of identifying pathology in patients with rotator cuff related
 pain, studies demonstrate that their correlation with clinical presentation is questionable.

 Shoulder pain is one of the most common sources of musculoskeletal pain that might affect up
 to 20% of the population. Additional important epidemiological data concerning shoulder pain
 is the fact that approximately 40% of people complaining of shoulder pain will still be
 symptomatic after six months. Physiotherapy has an important role in the management of
 rotator cuff related pain and exercise is the main therapeutic approach when considering pain
 and functional restriction,

 Mobilisation with movement (MWM) is one alternative musculoskeletal approach that focuses on
 improving active pain-free range of motion. This concept of treatment incorporates a passive
 accessory glide produced by the clinician, followed by an active movement executed by the
 patient. Different studies have suggested positive effects of MWM in patients complaining of
 shoulder pain. On the other hand, other studies reported no superior effects when using MWM
 in their studies. Several methodological aspects might have influenced this discrepancy in
 results, such as population, dosage and type of MWM utilized, follow-up period and outcome
 measures. Due to this uncertainty, the current research aims to further explore the inclusion
 of MWM to an exercise programme in patients with rotator cuff related pain.
Inclusion Criteria:

 -  Unilateral shoulder pain of atraumatic origin.

 -  Complaining of shoulder pain for at least six weeks.

 -  Scoring at least 3 out 10 on a numeric pain rating scale (0- no pain; 10- worst pain
 imaginable).

 -  Pain on active shoulder movement

 -  Pain provoked by at least three of the following tests: Hawkins-Kennedy, Neer, painful
 arc, resisted external rotation, empty or full can.

 -  Participants referred by a specialist under the diagnosis of subacromial impingement
 syndrome, rotator cuff tendinopathy, partial rotator cuff tears, subacromial pain,
 bursitis.

 Exclusion Criteria:

 -  Shoulder pain following a traumatic event.

 -  History compatible with complete rotator cuff and biceps rupture.

 -  Adhesive capsulitis.

 -  History of dislocation.

 -  Glenohumeral osteoarthritis.

 -  Cancer

 -  Systemic, local or self-immune inflammatory conditions.

 -  Previous shoulder or neck surgery.

 -  Familiar pain provoked by neck movements.

 -  Presence of radicular signs.

 -  Use of corticosteroids over the past six months.

 -  Diagnosis of fibromyalgia.

 -  Participants with clinical depression

 -  Participants under treatment for her/his shoulder condition.