Combined Effect of Manual Therapy, Electrotherapy, and Therapeutic Exercises in the Rehabilitation of Subacromial Impingement Syndrome: A Case Study

Abstract

Background: Subacromial impingement syndrome is a leading cause of shoulder pain and functional limitation, commonly managed through conservative rehabilitation strategies. Multimodal physiotherapy approaches that integrate manual therapy, electrotherapy, and therapeutic exercises are increasingly used in clinical practice; however, detailed evidence describing short-term outcome trajectories following structured, protocol-driven multimodal interventions remains limited, particularly at the individual patient level. Objective: To evaluate the effects of a four-week multimodal physiotherapy program on pain intensity, shoulder range of motion, and functional disability in a patient with subacromial impingement syndrome. Methods: This prospective case study was conducted in an outpatient rehabilitation setting and included a 42-year-old female diagnosed with subacromial impingement syndrome based on clinical examination. The intervention comprised a staged, four-week program integrating electrotherapy, manual therapy, and progressive therapeutic exercises. Pain intensity was assessed using the Visual Analogue Scale, functional disability using the Shoulder Pain and Disability Index, and shoulder range of motion using goniometric measurements. Outcomes were recorded at baseline and monitored weekly throughout the intervention period. Results: Pain intensity decreased progressively from 8/10 at baseline to 1/10 at week four, representing a clinically meaningful reduction. Shoulder flexion improved from 90° to 180°, abduction from 80° to 170°, external rotation from 40° to 85°, and internal rotation from 50° to 85°. Functional disability improved substantially, with the Shoulder Pain and Disability Index score decreasing from 62% at baseline to 10% at the end of the intervention. Conclusion: A structured multimodal physiotherapy program combining manual therapy, electrotherapy, and therapeutic exercises was associated with marked improvements in pain, shoulder mobility, and functional capacity in a patient with subacromial impingement syndrome, supporting the clinical value of integrated rehabilitation approaches.