Comparative Effectiveness of Mobilization With Movement and Passive Stretching in Shoulder Impingement Syndrome: A Randomized Controlled Trial

Abstract

Background: Shoulder impingement syndrome (SIS) is one of the most prevalent causes of shoulder pain and disability, leading to functional limitations and reduced quality of life. Conservative physiotherapeutic management remains the first-line treatment, yet the comparative clinical efficacy of different manual therapy approaches such as Mobilization With Movement (MWM) and passive stretching (PS) remains unclear. Previous studies have reported isolated benefits of these interventions, but direct head-to-head evidence is limited. Objective: To compare the effectiveness of MWM and PS, each combined with conventional physiotherapy, in improving pain, functional disability, and range of motion (ROM) among patients with SIS. Methods: This randomized controlled trial included 105 adults (aged 20–45 years) with clinically diagnosed SIS, randomly allocated into three groups (n=35 each): Group I received MWM plus conventional therapy, Group II received PS plus conventional therapy, and Group III received conventional therapy alone (control). Interventions were administered twice weekly for five weeks. Primary outcome was change in Shoulder Pain and Disability Index (SPADI); secondary outcomes included Visual Analogue Scale (VAS) pain and goniometric ROM in flexion, extension, abduction, and rotations. Data were analyzed using ANCOVA adjusted for baseline values, with significance set at p<0.05. Results: MWM achieved the greatest improvement in SPADI (mean reduction −14.45; 95% CI −17.2 to −11.5; p<0.001) and VAS pain (−3.35; 95% CI −3.9 to −2.7; p<0.001) compared to PS and control. ROM gains were largest in the MWM group, particularly for abduction (+23.6°) and medial rotation (+21.6°), with significant between-group differences (p<0.001). Effect sizes for functional and pain outcomes were large (Cohen’s d >1.0), confirming both statistical and clinical significance. Conclusion: MWM combined with conventional physiotherapy yields superior pain reduction, functional recovery, and shoulder mobility improvement compared to PS or standard therapy alone in SIS patients. These results support MWM as a preferred conservative intervention for optimizing rehabilitation outcomes.