Effect of Eccentric Exercises with Maitland Mobilization on Pain, Muscle Activity and Function in University Athletes with Shoulder Impingement; A Randomized Controlled Trial

Shoulder impingement syndrome (SIS) is characterised by a compression of the subacromial structures between the humeral head and the coracoacromial arch, which results in a wide range of symptoms (Ludewig and Cook, 2002). Many athletes have SIS, a prevalent musculoskeletal ailment that affects overhead athletes, at some time in their careers (Mohseni-Bandpei et al., 2012). 27% of all shoulder injuries in university athletes are SIS (Laudner et al., 2009). The most prevalent clinical characteristics are arm pain, restricted range of motion, and diminished arm strength. Inadequate scapular fixation and mechanical impacts can also cause the subacromial space to shrink, endangering the subacromial space and associated components (Seitz et al., 2011). According to a systematic review, there is insufficient evidence to support the use of exercise therapy alone as a treatment for SIS (Steuri et al., 2017). Therefore, it emphasises the value of exercise therapy in conjunction with other therapies like manual therapy (Steuri et al., 2017). For the treatment of SIS, a trial found that combining manual therapy with exercise therapy had notable and better outcomes. Exercise therapy has been shown to increase range of motion, whilst manual therapy has been shown to increase capsular extensibility (Sharma et al., 2021). The idea of combining manual therapy with exercise therapy seems to offer potentially beneficial treatment outcomes for SIS, taking into account the physiological ideas and literature that have been examined. The goal of the combination of these two therapies is to increase shoulder joint range of motion and promote extensibility (Bishop et al., 2015). One of the most used physical therapies in the field of musculoskeletal rehabilitation is the maitland joint mobilisation technique, which is primarily used to treat limited movement and bone and joint discomfort (Liu et al., 2024). According to a recent systemic review, eccentric strengthening may have a minor but likely insignificant impact on pain in SIS when compared to other treatments, and its advantage in terms of function is debatable (Larsson et al., 2019). Prior research has demonstrated that eccentric exercise is preferable than nonprogressive movement activities in terms of pain, function, and strength in SPS (Chacoonas et al., 2017). However, for pain and function in this population, eccentric exercise does not appear to be more advantageous than conventional strengthening that incorporates both eccentric and concentric phases (Dejaco et al., 2017). Furthermore, prior research evaluating the efficacy of isolated eccentric and isolated concentric strengthening in SPS has produced contradictory findings, suggesting that either eccentric strengthening is superior or that the benefits in both groups are comparable (Macías-Hernández et al., 2021). So, this study will be measuring the effects of eccentric training combined with maitland mobilization in improving pain, muscle activity and function in athletes with shoulder impingement.