A comparison of two mobilization approaches on the acromiohumeral distance in overhead athletes with primary subacromial impingement syndrome: a randomized clinical study

Shoulder mobilization techniques, with and without movement, may restore the range of intra-articular glenohumeral motions and expand the subacromial space during arm abduction. The primary purpose of this study was to measure and compare the acromiohumeral distance at three static angles of passive scapular arm abduction (no arm abduction, 45° of arm abduction, and 60° of arm abduction) in overhead athletes diagnosed with primary subacromial impingement syndrome, before and after shoulder mobilization techniques with and without movement, combined with contemporary physical therapy. Fifty-one overhead athletes diagnosed with primary subacromial impingement syndrome were randomly assigned to three parallel groups. One intervention group received the Mulligan shoulder mobilization techniques, whereas the other intervention group received the Maitland shoulder mobilization techniques. Both mobilization approaches were accompanied by contemporary physical therapy and were administered every other day for two weeks. The control group received no specific intervention for two weeks. Using an ultrasound device, the acromiohumeral distance was assessed in the intervention groups one day before and one day after treatment with manual therapy and in the control group at two-week intervals. Both the Mulligan and Maitland approaches significantly increased the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001). In contrast, no significant changes were observed in the control group (p-values > 0.317).The Mulligan approach, compared to the Maitland approach, exhibited significantly greater increases in the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001). Both the Mulligan and Maitland shoulder mobilization techniques, combined with contemporary physical therapy, significantly increased the acromiohumeral distance at static angles of passive scapular arm abduction in individuals suffering from primary subacromial impingement syndrome. Moreover, the Mulligan approach provided significantly greater improvements in the acromiohumeral distance compared to the Maitland approach.