Manual therapy on the diaphragm is beneficial in reducing pain and improving shoulder mobility in subjects with rotator cuff injury: A randomized trial

Abstract

Background

Rotator cuff dysfunction is the main cause of shoulder pain. The shoulder and the diaphragm have an important relationship through the myofascial system and through its innervation.

Objectives

To analyse the effect of diaphragm manual therapy on the symptoms of patients with rotator cuff injury compared to manual treatment on shoulder muscles.

Design

A randomized, controlled, single-blind trial of 45 participants diagnosed with rotator cuff injury.

Method

The sample were divided into 3 groups of treatment.

1. Manual treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (Control/Shoulder group -SG-).

2. Diaphragm manual therapy techniques (Diaphragm group -DG-).

3. Active diaphragm mobilization by hypopressive gymnastic exercise (Breathing group -BG-).

Shoulder pain using a numerical rating scale (NRS), shoulder range of motion (ROM), and pressure pain threshold (PPT) were evaluated, and compared between groups.

Results

Both the SG and DG showed a clinically significant improvement, as well as a significant effect size, on the NRS in shoulder flexion and abduction movements. Regarding ROM improvement, only the SG obtained a significant effect size (abduction and external rotation). The PPT at the xiphoid process of the sternum showed a clinically significant improvement in the DG.

Conclusion

Indirect treatment of the shoulder through a protocol of manual therapy techniques on the diaphragm and intervention on MTP of the rotator cuff have been clinically effective in reducing pain on the NRS immediately, in flexion and abduction movements of the shoulder, and more effective compared to the intervention in the breathing group.

Clinical trial registration number

NCT03293329.