Multimodal Manipulative Therapy for Shoulder Pain

INTERVENTION: Manipulation, soft tissue procedures, rehabilitation exercises. The active therapeutics include a combination of manipulation, soft tissue therapy and rehabilitation exercises (multimodal therapy) Manipulation involves a high velocity low amplitude procedure directed at either the low cervical spine, upper thoracic spine, glenohumeral or acromioclavicluar joints dependent on clinical finings i.e. detection of manipulable lesion or fixated joint. Soft tissue therapy includes ischaemic pressure massage administered to tight or spasmed muscles and tight muscle stretches. Rehabilitation exercises including isometric followed by isotonic strengthening exercies directed at the rotator cuff muscles. These exercises are to be performed at home by the participants. The duraion of each treatment session is between 15‐20 minutes. Each participant will recieve a total of 8 treatments at a frequency of 2 times per week for 4 weeks. CONDITION: Shoulder pain PRIMARY OUTCOME: Visual analogue scale (VAS) pain levels ; Orthoaedic tests SECONDARY OUTCOME: Orthopaedic range of motion ; All ranges of motion of the glenohumeral joint and cervical spine will be measured. ; Measurement will be conducted by a blinded research assistant with a hand held goniometer and pleurimeter. ; Measurements taken at baseline, at 4 weeks after treatment completion and at 4 months after treatment completion INCLUSION CRITERIA: Presence of shoulder pain in the anterior , lateral and posterior aspects of the shoulder inclduing the low cervical spine