Effects of Diaphragm Muscle Therapy on Pain and Shoulder Movement in Subjects With Rotator Cuff Injuries

This study is a randomised controlled trial evaluating clinical effects of a diaphragm treatment, via manual release or active mobilization, comparing with a standard treatment of shoulder myofascial trigger points release.

A description of the 3 groups of treatment:

1. \- Experimental group 1: 3 diaphragm stretching techniques according to Chaitow, Ward and Ricard, performed by a physical therapist are employed in this experimental group during 10 minutes. The participants are situated in a seated, supine and side bending position.
2. \- Experimental group 2: diaphragm mobilization through active hipopressive gymnastic exercise according to Caufriez in two different postures.
3. \- Active comparator group: A ischemic compression technique in most painful myofascial trigger points in the infraespinatus and supraespinatus muscle during one minute each one.

The shoulder flexion, abduction and external rotation range of motion will be assessed pre and postinterventions, as well as the pressure pain threshold with an algometer and the pain experienced by the individual in shoulder mobility with a Numerical Rating Scale.

• Diaphragm manual therapy techniques (Other): 3 diaphragm manual therapy techniques performed by a physical therapist are employed in this experimental group during 10 minutes. The participants are situated in a seated, supine and side bending position.
• Diaphragm mobilization through active hipopressive gymnastic exercise (Other): Diaphragm mobilization through active hipopressive gymnastic exercise in two different postures: standing and standing bending forward.
• Ischemic compression techniques in shoulder myofascial trigger points (Other): Ischemic compression techniques in infraespinatus and supraespinatus myofascial trigger points during one minute each muscle. The pressure increases gradually until the individual feels a tolerable pain.

Primary outcomes

• Change from baseline to post intervention shoulder range of motion with a digital inclinometer [Baseline and Immediately Post Intervention]: Pre and post treatment assessment of flexion, abduction and external rotation at 90º abduction movements in supine, registered with a Baseline digital inclinometer
• Change from baseline to post intervention pressure pain threshold in supraespinatus tendon and xiphoid process with a pressure algometer [Baseline and Immediately Post Intervention]: Pre and post treatment Pressure pain threshold in supraespinatus tendon and xiphoid process registered with a pressure algometer in a supine position
• Change from baseline to post intervention Numerical Rating Pain Scale in shoulder mobility [Baseline and Immediately Post Intervention]: Pre and post treatment Numerical Rating Pain Scale in shoulder mobility: flexion, abduction and external rotation at 90º abduction standing

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Participants of both genders aged between 18 and 65 years old
* Ultrasound and/or magnetic resonance imaging diagnosis of rotator cuff injury
* Pain or range of movement restriction in active shoulder flexion and/or abduction

Exclusion Criteria:

* Use of analgesic or anti-inflammatory drugs 72 hours prior to the study
* Individuals with glenohumeral instability due to shoulder luxation or subluxation or Bankart labrum injury
* Individuals who have received physical therapy treatment in last week
* Individuals who underwent thoracic or shoulder surgery or people suffering from rheumatisms
* Diabetic patients
* People with a diagnosed neurological pathology
* Individuals with a diagnosed mental health problem
* Not being able to understand and sign the informed consent and information sheet

• Study Protocol (PDF, 2017-11-24)
• Statistical Analysis Plan (PDF, 2017-11-24)

NIH grants: 2017