Exercise therapy plus manual therapy improves acromiohumeral distance measured by real-time ultrasound in overhead athletes with shoulder impingement syndrome

Introduction
Shoulder impingement syndrome (SIS), characterized by decreased acromiohumeral distance (AHD), is a promising objective outcome measure with both clinical and research utility. The purpose of this study was to evaluate and compare the effectiveness of combining exercise therapy and manual therapy with motor control exercise on AHD in overhead athletes with SIS.

Material and methods
Ten overhead athletes with clinically diagnosed SIS were randomly assigned to two groups. The ET plus MT group received the exercise therapy plus manual therapy regime, and the MCE group followed the motor control exercise protocol. Both groups underwent eight weeks of intervention, and AHD was evaluated at three levels of abduction (0°, 45°, 60°) with real-time ultrasound (RTUS). The AHD evaluation was performed at baseline and at end of intervention (week 8).

Results
AHD improvement was noted at all three levels only in the ET plus MT group and the mean difference was found to be 2.62 ± 0.18mm (0°), 3.28 ± 0.40mm (45°) and 3.77 ± 0.30mm (60°). Statistical analysis performed with two-way repeated measures ANOVA (3x2) revealed significant group effects for AHD (0°: F(2,1.10) = 0.76, p < 0.001; 45°: F(2,0.98) = 0.80, p < 0.001; 60°: F(2,0.95) = 0.84, p < 0.001). Time effect and interaction effects were also found to be significant.

Conclusions
ET plus MT appears to be a more effective rehabilitation tool than MCE since it improves AHD at 0°,45°, 60° in overhead athletes with SIS.