Influence of fascial manipulation on range of motion, pain, and functions in individuals with chronic shoulder pain

Introduction: Shoulder disorders account for 15% to 30% of common musculoskeletal pain in which 50% of patients complain of chronic pain (Lozano et al 2011). Various anatomical studies have shown the existence of myofascial chains linked by deep fascia along the upper extremity. Any alterations in these deep fasciae could be a source of shoulder pain (Day et al 2009). So, treatment methods considering the entire myofascial sequence (MS) may be crucial in managing such conditions. Fascial manipulation (FM) involves kneading of the deep fascia at certain points called centers of co-ordination (CC) along these MS that might restore the gliding of the intra-fascial fibers thereby reducing pain and improving function. The objective of this study is to find the effect of FM in pain, range of motion (ROM), and function in individuals with chronic shoulder pain. Methods: Single group pre-test post-test study design Subjects: After obtaining approval from the Institutional Research and Ethical committee, 18 individuals with chronic shoulder pain aged 18-45 years were recruited. Setting: Manipal Academy of Higher Education Outcome Measures: Numerical Pain Rating Scale (NPRS), Range of Motion (ROM) using goniometer, Disability of Arm, Shoulder, and Hand (DASH) score, Pain Pressure Threshold (PPT) using algometer. All outcomes except DASH were measured before and immediately after FM as well as on the 7th day. DASH was assessed prior to FM intervention and then on the 7th day. Results: Sixteen participants have completed the trial. The Friedman test was used to analyze the collected data which showed that there were statistically significant differences in ROM and NPRS before and after FM on the first day as well as between day 1 and day 7 (p < 0.05). The Wilcoxon signed rank test showed statistically significant difference I the DASH scores between day 1 and day 7 (p < 0.05). Repeated measures ANOVA revealed no statistically significant differences in the pain pressure threshold of upper trapezius, pectoralis minor, and teres minor (p > 0.05). Conclusion: FM can be used as an effective treatment strategy in improving the ROM and functions as well as decreasing the pain in chronic painful shoulder conditions. References: Day JA, Stecco C, Stecco A. Application of fascial manipulation technique in chronic shoulder pain-Anatomical basis and clinical implications. Journal of Bodywork and movement therapy, 13:128-135, 2009 Lozano H, Madeleine P, Caldero C, Ferna C. Elite swimmers with and without unilateral shoulder pain. Mechanical hyperalgesia and active / latent muscle trigger points in neck-shoulder muscles. Scand J Med Sci Sports, 23(1) 1–8, 2011.