The effects of focused extracorporeal shockwave therapy versus deep friction massage in supraspinatus tendinopathy: A randomized controlled trial

PURPOSE

The purpose of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) and deep friction massage (DFM) in treating supraspinatus tendinitis in non-professional athletes.

METHODS

Thirty-two non-professional athletes diagnosed with supraspinatus tendinitis were randomly assigned to either the ESWT group with therapeutic exercise or the DFM group with therapeutic exercise. Outcome assessments were conducted before the intervention, after 12 sessions, and one week later. The primary outcomes measured were pain intensity and the pressure pain threshold (PPT) of the supraspinatus and deltoid muscles. Secondary outcomes included shoulder abduction, external rotation, supraspinatus strength, and quality of life. Between-group comparisons were performed using one-way ANOVA/ANCOVA, and effect sizes were calculated.

RESULTS

The group × time interaction was significant for pain (p = 0.011), PPT (p = 0.04), and shoulder abduction (p = 0.04), while no significant interaction was found for shoulder external rotation or supraspinatus strength (p > 0.05). Within-group analysis revealed significant improvements in all outcomes compared to baseline in both groups.Between-group comparisons demonstrated the superior effectiveness of shockwave therapy in improving pain (p = 0.024, effect size = -0.84), increasing the PPT of the supraspinatus (p = 0.0001, effect size = 1.65) and deltoid (p < 0.0001, effect size = 2.61), and enhancing shoulder abduction (p = 0.001, effect size = 1.31). Effect sizes indicated high efficacy (greater than 0.8) favoring shockwave therapy. However, no significant differences were observed between the groups in shoulder external rotation (p = 0.2), supraspinatus strength (p = 0.42), or quality of life (p = 0.97).

CONCLUSIONS

This study concludes that shockwave therapy is significantly more effective than deep friction massage for managing supraspinatus tendinitis.

Effectiveness of trigger point manual therapy for rotator cuff related shoulder pain: a systematic review and meta-analysis

PURPOSE

To evaluate the effectiveness of trigger point manual therapy (TPMT) in treating rotator cuff related shoulder pain (RCRSP).

METHODS

Randomized controlled trials that compared the effects of TPMT with no or other conservative treatments in patients with RCRSP were included. Primary outcomes were shoulder pain intensity and function. Secondary outcomes were pressure pain threshold (PPT) and number of myofascial trigger points (MTrPs). The Cochrane Risk of Bias 2.0 tool, PEDro scale and GRADE approach were employed.

RESULTS

Ten studies were included in this systematic review and seven in the meta-analysis. Very low to low quality of evidence showed no statistically significant difference between TPMT and other conservative treatments in rest and activity pain reduction in the short term (3 days to 12 weeks), and the difference in shoulder function was statistically significant in favor of TPMT. Furthermore, TPMT was found to be effective in the improvement of PPT and the inactivation of active MTrPs in the short term.

CONCLUSION

TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term, and slightly more effective for functional improvement. TPMT seems to be effective to treat the active MTrPs in RCRSP.

REGISTRATION NUMBER

CRD42023409101.

The effect of friction massage on pain intensity, PPT, and ROM in individuals with myofascial trigger points: a systematic review

INTRODUCTION

Friction massage (FM) is a conservative treatment for managing myofascial trigger points (MTrPs). Although many studies have demonstrated the effects of FM, this manual technique significantly loads the therapist's hands. Therefore, there is a need to evaluate FM compared to other physical therapy methods to help clinicians choose the best one.

OBJECTIVE

This systematic review aimed to investigate the effect of FM on pain intensity, pressure pain threshold (PPT), and joint range of motion (ROM) in individuals with MTrPs.

METHODS

PubMed/Medline, Scopus, Web of Science, Science Direct, and Google Scholar were searched from inception to 15 April 2024. All randomized control and clinical trials that assessed the effect of FM on pain intensity, PPT, and joint ROM in individuals with MTrPs were included.

RESULTS

Twelve studies were included. The within-group results showed that FM could significantly improve pain intensity, PPT, and joint ROM, but compared to the control group, there was no significant superiority for improving pain intensity and PPT, and the results were inconclusive for the effect of FM on joint ROM improvement because of controversial findings.

CONCLUSION

In the short term, there is level C evidence indicating that FM may effectively reduce VAS and the PPT of MTrPs in upper trapezius. Nonetheless, high-quality and long-term research is needed to address improvements in ROM and NPRS. Due to nature of level C evidence, future well-designed RCTs should overcome the existing limitations using adequate sample sizes, long intervention periods, and long-term follow-up.

Effects of acupuncture on shoulder impingement syndrome: A systematic review and meta-analysis

BACKGROUND

Shoulder impingement syndrome (SIS) is a common condition that causes chronic shoulder pain. The effectiveness of acupuncture in treating chronic shoulder pain has been documented in previous studies; however, existing systematic reviews and meta-analyses have often excluded Chinese databases and combined different types of acupuncture interventions, such as electroacupuncture, warm acupuncture, pharmacopuncture, and acupotomy. Thus, this study specifically examines the exclusive impact of manual acupuncture on SIS.

METHODS

Several databases, including PubMed, Cochrane Central, Embase, 1 Chinese database (China National Knowledge Infrastructure), and 5 Korean databases (ScienceON, Oriental Medicine Advanced Searching Integrated System, KoreaMed, Korean Studies Information Service System, and KMBASE), were systematically searched for relevant studies. The quality of the included studies was evaluated using the Cochrane Assessment Tool for Risk of Bias Version 2. Data collected from the selected studies were synthesized for meta-analysis. The primary outcome was a pain scale score, and the secondary outcomes were shoulder function and disability.

RESULTS

This study included 5 randomized controlled trials. The primary outcome assessment revealed significantly reduced pain (standardized mean difference [SMD] = -0.50, 95% confidence interval [CI] = -0.74 to -0.27) and improvements in shoulder function and disability (SMD = -0.57, 95% CI = -0.96 to -0.19). A subgroup analysis based on treatment duration indicated that short-term acupuncture treatment (≤4 weeks) exhibited a high level of confidence with low heterogeneity (SMD = -0.37, 95% CI = -0.73 to -0.02).

CONCLUSION

Manual acupuncture is effective for relieving pain and improving shoulder function and disability in patients with SIS. However, further research is necessary to validate these findings owing to the limited number of patients and heterogeneity among the studies reviewed.

Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis

BACKGROUND

Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain.

METHODS AND FINDINGS

Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7).

CONCLUSION(S)

Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.

Dry Needling Alone or in Combination with Exercise Therapy versus Other Interventions for Reducing Pain and Disability in Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined the effects of dry needling alone or in combination with exercise therapy for reducing pain and disability in people with subacromial pain syndrome. Systematic searches of randomized clinical trials (RCTs) were performed in five different databases. A meta-analysis was carried out with the data obtained, and the risk of bias and quality of the studies was assessed using the Cochrane ROB 2.0 and GRADE tools. Finally, five RCTs (n = 315) were included in the meta-analysis and qualitative analysis. Our results determine that dry needling alone or combined with exercise therapy showed improvements in pain in the short-term (5RCTs: SMD: -0.27; [-0.49, -0.05]; low-quality) and mid-term (4RCTs: SMD: -0.27; [-0.51, -0.04]; low-quality) compared to a range of interventions. However, no differences were shown for disability at short-term (3 RCTs: SMD: -0.97; [-2.04, 0.11]; very-low quality) and mid-term (3 RCTs: SMD: -0.85; [-1.74, 0.04]; very-low quality). Dry needling alone or in combination with exercise therapy may result in a slight reduction in pain in the short-term and mid-term. However, the evidence about the effect of this therapy on disability in the short- or mid-term is very uncertain compared to the range of interventions analyzed in this systematic review (Registration: INPLASY202260112).