Does Extracorporeal Shockwave Therapy Replace Joint Mobilization for the treatment of Subacromial Impingement

Subacromial impingement is one of the most common shoulder dysfunctions in clinical practice. Extracorporeal shockwave (ESWT) is noninvasive therapeutic modality has evolved as option for management of different musculoskeletal disorders. The aim of this study was to compare between the effectiveness of extracorporeal shockwave and joint mobilization in the treatment of sub acromial impingement. The study was designed as a randomized controlled trial. Sixty patients with subacromial impingement were randomly assigned to an ESWT group (n=20), mobilization group (n=20), and control group (n=20). The ESWT intervention consisted of one session weekly for 4 weeks with total of 6000 impulses (energy flux density, 0.11 mJ /mm(2)). The joint mobilization intervention consisted of three sessions per week for up to 6 weeks. Outcome measures were the visual analog scale (VAS), shoulder disability questioner (SDQ), and active range of motion (ROM) of the shoulder joint. Analyses of variance test was used to determine differences between groups for all measured parameters. Paired t-test was used to compare between the pre- and post-treatment values within groups.For the 60 study participants (28 women and 32 men; mean age=44.1 +/- 7) years there were no between-group differences at baseline in VAS, SDQ score, and ROM of the shoulder joint. At the end of the 6-week of intervention, subjects in ESWT and mobilization groups experienced significant decrease in pain , improve in shoulder function, and increased ROM than those in the control group (p< 0.05) . Pain and shoulder function were significantly improved in ESWT group compared with the mobilization group, while shoulder ROM was more significantly increased in the mobilization group than in the ESWT group. The results suggest that ESWT could be more effective treatment modality for management of subacromial impingement than joint mobilization when pain and functional disability are the main patient complains.