Study Design: Randomized controlled trial. Objective: To evaluate the effects of an exercise protocol, with and without manual therapy, on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome. Background: Stretching and strengthening exercises have been shown to effectively decrease pain and disability in individuals with shoulder impingement syndrome. There is still conflicting evidence regarding the efficacy of adding manual therapy to an exercise therapy regimen. Methods: Forty-six patients were assigned to 1 of 2 groups, one of which received a 4-week intervention of stretching and strengthening exercises (exercise alone) and the other the same intervention, supplemented by manual therapy targeting the shoulder and cervical spine (exercise plus manual therapy). All outcomes were measured preintervention and postintervention at 4 weeks. Outcome measures were scapular kinematics in the scapular and sagittal planes during arm elevation, function as determined through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, pain as assessed with a visual analog scale, and mechanical sensitivity as assessed with pressure pain threshold. Results: Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed postintervention. A significant group-by-time interaction effect (P = .001) was found for scapular anterior tilt during elevation in the sagittal plane, with a 3.0° increase (95% confidence interval [CI]: −1.5°, 7.5°) relative to baseline in the exercise-plus–manual therapy group compared to a decrease of 0.3° (95% CI: −4.2°, 4.8°) in the exercise-alone group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period. Conclusion: Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics. The study is registered at www.clinicaltrials.gov (NCT02035618). Level of Evidence: Therapy, level 1b-. J Orthop Sports Phys Ther 2015;45(12):984–997. Epub 15 Oct 2015. doi:10.2519/jospt.2015.5939

Objectives: To identify the presence of myofascial trigger points (TrPs) and pressure pain threshold (PPT) levels in the shoulder muscles of both involved and uninvolved sides in patients with unilateral shoulder impingement syndrome (SIS). Methods: Twenty-seven patients with SIS and 20 matched control patients participated in this study. TrPs of 10 shoulder muscles and 8 PPTs, including tibialis anterior PPT, were assessed. Results: SIS group showed a greater number of TrPs (t=−2.697; P=0.010) than the control group. The muscles of the uninvolved side of the SIS group also presented some active TrPs. PPTs showed small differences between involved and uninvolved sides of patients with SIS and higher differences between both sides of the SIS group and dominant side of controls although with significant difference only in the supraspinatus PPT (F=3.239; P=0.045). The muscle PPTs of the patients presenting TrPs in each muscle of the involved side were lower than the PPTs of the patients without TrPs in the same muscle for both involved and uninvolved sides with few significant differences. Discussion: The high number of TrPs in the involved side of patients with SIS suggests the presence of peripheral sensitization. The results reject the presence of central alterations. Finally, the patients with unilateral SIS may present bilateral deficits related to myofascial pain.

This study investigated the effects of 5 and 15°C cold-water immersion on recovery from exercise resulting in exercise-induced muscle damage. 42 college-aged men performed 5×20 drop-jumps and were randomly allocated into one of 3 groups: (1) 5°C; (2) 15°C; or (3) control. After exercise, individuals from the cold-water immersion groups had their lower limbs immerged in iced water for 20 min. Isometric knee extensor torque, countermovement jump, muscle soreness, and creatine kinase were measured before, immediately after, 24, 48, 72, 96 and 168 h post-exercise. There was no between-group difference in isometric strength recovery (p=0.73). However, countermovement jump recovered quicker in cold-water immersion groups compared to control group (p<0.05). Countermovement jump returned to baseline after 72 h in 15°C, 5°C group recovered after 96 h and control did not recovered at any time point measured. Also, creatine kinase returned to baseline at 72 h and remained stable for all remaining measurements for 15°C group, whereas remained elevated past 168 h in both 5°C and control groups. There was a trend toward lower muscle soreness (p=0.06) in 15°C group compared to control at 24 h post-exercise. The result suggests that cold-water immersion promote recovery of stretch-shortening cycle performance, but not influence the recovery of maximal contractile force. Immersion at warmer temperature may be more effective than colder temperatures promoting recovery from strenuous exercise.

The aim of this study was to investigate the effects of multiple cold-water immersions (CWIs) on muscle function, markers of muscle damage, systemic inflammation and ECM degradation following exercise-induced muscle damage (EIMD). Thirty physically active males were randomly assigned to either a control (n = 15) or cold-water immersion (CWI) group (n = 15). The CWI group performed one immersion (10 °C for 20 min) at post-exercise and every 24 h for the following 72 h, while the control group remained in a seated position during these corresponding periods. Muscle strength, vertical jump height, muscle thickness, delayed-onset muscle soreness (DOMS), systemic creatine kinase (CK), C-reactive protein (CRP), inflammatory cytokines and matrix metalloproteinase-2 (MMP-2) activity were assessed at Pre, Post, 24, 48, 72, 96 and 168 h following EIMD. No significant time × group interaction was obtained for muscle strength, vertical jump height recovery and MMP-2 activity (p > 0.05). At 24 h, muscle thickness from the CWI group returned to baseline and was lower than the control (p = 0.04). DOMS returned to baseline at 168 h for the CWI group (p = 0.109) but not for the control (p = 0.008). At 168 h, CK showed a time-group difference with a greater peak for the control group (p = 0.016). In conclusion, multiple CWIs attenuated muscle damage, but not altered systemic inflammation and muscle function recovery.