The Effect of Mobilization With Movement on Function, Disability, and Pain in Patients With Rotator Cuff Lesions: A Double-Blind Randomized Controlled Trial

Rotator cuff lesions are among the most common causes of shoulder pain and functional limitation, particularly in middle-aged and older adults. Due to the wide range of motion and complex biomechanics of the glenohumeral joint, integrity of the rotator cuff muscles is essential for dynamic stability, coordinated movement, and precise joint positioning. Pathological changes in the rotator cuff may lead not only to pain and reduced functional capacity but also to impairments in proprioception, which can negatively affect motor control and increase the risk of recurrent injury.

Conservative management is widely recommended as the first-line treatment for rotator cuff lesions and typically includes therapeutic exercises, physical agents, and manual therapy techniques. Mobilization with Movement (MWM), developed within the Mulligan concept, is a manual therapy approach that combines sustained accessory joint mobilization with active, pain-free physiological movement. MWM is proposed to improve joint mechanics, reduce pain, and enhance neuromuscular and proprioceptive input. While previous studies have demonstrated the effectiveness of MWM in reducing pain and improving function in various musculoskeletal conditions, evidence regarding its effects on shoulder proprioception, particularly joint position sense, in individuals with rotator cuff lesions remains limited.

This randomized controlled trial is designed to evaluate the effects of MWM on pain, functional outcomes, and joint position sense in patients with rotator cuff lesions. Eligible participants diagnosed with rotator cuff pathology will be randomly assigned to one of three groups: (1) Mobilization with Movement (MWM) group, (2) conventional physiotherapy group, or (3) task oriented training group. Randomization will be performed after baseline assessment to ensure allocation concealment.

All participants will undergo standardized assessments at baseline (pre-intervention) and after completion of the intervention period (post-intervention). Functional status of the upper extremity will be evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain intensity will be assessed using validated self-report measures. Shoulder proprioception will be assessed through a joint position sense test using an active repositioning method during shoulder flexion with a laser pointer system, recording the deviation from a predefined target point in centimeters.

The MWM group will receive manual therapy interventions based on Mulligan principles, applied by a trained physiotherapist, in addition to standard care. The conventional physiotherapy group will receive commonly used rehabilitation interventions excluding MWM techniques. The control group will not receive therapeutic intervention during the study period. All procedures will be conducted in accordance with the Declaration of Helsinki, and written informed consent will be obtained from all participants prior to enrollment.