Type of Article:  Original Research

Volume 9; Issue 3 (June 2021)

Page No.: 3825-3833

DOI: https://dx.doi.org/10.16965/ijpr.2021.121

Comparison of exercise therapy and ultrasonic therapy in the treatment of shoulder impingement syndrome

Bhargava Shanker *1, D. Rajesh Reddy 2, N.S.S.N. Balaji 3.

*1 Associate Professor, MNR Sanjeevani college of physiotherapy and MNR Hospital, Sangareddy, Telangana, India.

2,3 Professor, MNR Sanjeevani college of physiotherapy and MNR Hospital, Sangareddy, Telangana, India.

Corresponding Author: Dr. Bhargava Shanker, PT., Associate Professor, MNR Sanjeevani college of physiotherapy and MNR Hospital, Sangareddy, Telangana, India.   E-Mail: bhargavchowdary.bk@gmail.com


Background: The shoulder is one of the most frequent sites of musculoskeletal pain, the incidence of shoulder pain in primary care patients is estimated to be 11.2 per 1000 per year.  a considerable number of people with shoulder pain (41%) show persistent symptoms after 1 year. Comparing the exercise therapy and ultrasound therapy (UST) for impingement syndrome.

Methodology: The study was conducted at OPD of MNR Hospital in Sangareddy. The study was conducted for a period of 3 weeks. A total number of 30 subjects were selected by simple random sampling after explained to all the participants and an informed consent was taken from each subject. 30 subjects were randomly divided into 2 Groups. Exercise therapy was given to Group 1 and UST was given to Group 2. Both the Groups received exercise therapy and ultrasonic therapy in shoulder impingement syndrome. Subjects were evaluated pre and post-treatment for VAS (Visual Analogue Scale) score, SPADI SCORE (Shoulder Pain and disability index) shoulder ROM.

Outcome measures: VAS scale, SPADI score.

Results and Discussion: To test the significance of the mean difference of two groups, unpaired t test was done.  It is statistically shown that there is some significant impact in the parameters VAS, SPADI and shoulder ROM. The results showed that, group-I had more significant improvement in all parameters than group –II.

Conclusion: It is concluded that exercise therapy is better than ultrasonic therapy for subjects with shoulder impingement syndrome.

Key words: Exercise Therapy, Ultrasonic Therapy, Shoulder Pain and disability index, Range of Motion.


[1]. Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, Zhang TY, Jiang ZC, Welle K, Kabir K. Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis. Medicine (Baltimore). 2015 Mar;94(10):e510.
[2]. García I, Lobo C, López E, Serván JL, Tenías JM. Comparative effectiveness of ultrasonophoresis and iontophoresis in impingement syndrome: a double-blind, randomized, placebo controlled trial. Clin Rehabil. 2016 Apr;30(4):347-58.
[3]. Granviken F, Vasseljen O. Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trialJ Physiother. 2015 Jul;61(3):135-41.
[4]. Moezy A, Sepehrifar S, Solaymani Dodaran M. The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Med J Islam Repub Iran. 2014 Aug 27;28:87.
[5]. Calis HT, Berberoglu N, Calis M. Are ultrasound, laser and exercise superior to each other in the treatment of subacromial impingement syndrome? A randomized clinical trial. Eur J Phys Rehabil Med. 2011 Sep;47(3):375-80.
[6]. Zhou Z., Salle J. Y., Daviet J. C., Stuit A., Nguyen C. L. Combined approach in bedside assessment of aspiration risk post stroke: PASS. European Journal of Physical and Rehabilitation Medicine 2011 September;47(3):441-6
[7]. Angela R. Tate, Philip W. McClure, Ian A. Young, Renata Salvatori, Lori A. Michener, Comprehensive Impairment-Based Exercise and Manual Therapy Intervention for Patients With Subacromial Impingement Syndrome: A Case Series journal of orthopaedic & sports physical therapy 2010;40(8):474-93.
[8]. Celik, D., Atalar, A.C., Sahinkaya, S., Demirhan, M. The value of intermittent ultrasound treatment in subacromial impingement syndrome. Acta Orthop Traumatol Turc. 2009;43(3):243-7.
[9]. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. journal of orthopaedic & sports physical therapy. 2007 Mar;37(3):108-14.
[10]. MacDermid JC, Solomon P, Prkachin K. The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC musculoskeletal disorders. 2006 Dec;7(1):1-1.
[11]. Kurtaiş., Gürsel, Y., Ulus, Y., Bilgiç, A., Dinçer, G., van der Heijden, G.J. Adding Ultrasound in the management of soft tissue disorders of the shoulder: a Randomized placebo-controlled trial. Phys Ther. 2004;84(4):336-43.
[12]. Bang, M.D., Deyle, G.D. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports PhysTher, 2000;30:126–137.
[13]. Heald SL, Riddle DL, Lamb RL. The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure. Phys Ther. 1997 Oct;77(10):1079-89.
[14]. Game AN, Johannsen F. Ultrasound therapy in musculoskeletal disorders: a meta-analysis. Pain. 1995 Oct;63(1):85-91.
[15]. Pribicevic, M., Pollard, H., Bonello, R., De Luca, K., 2010. A systematic review of manipulative therapy for the treatment of shoulder pain, Manipulative PhysiolTher, 2010;33(9):679-89.
[16]. Purdy, S., Williams, J.R. A comparison of functional, patient-based scores in subacromial impingement. Journal of Shoulder and Elbow Surgery, 2005;14:380-384.
[17]. Brotzman, S.B., Wilk, K.E., 2003. Clinical orthopedic rehabilitation, 2nd ed., United Kingdom-Mosby.
[18]. Roy, J.S.,Moffet, H., Hebert, L.J., Lirrette, R. Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: A single-subject study design, Manual therapy, 2007;14:180-188.
[19]. Santamato, A., Solfrizzi, V., Panza, F., Tond, G., Frisardi, V., Leggin, B.G., Ranieri, M., Fiore, P. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. PhysTher, 2009;89(7):643-52.
[20]. Somty, R., 2002. OMT: what is it? International Federation of Orthopaedic Manipulative Therapists Web site [Online] Available at: http://www.omt.org/homepage/omt/omt.html. [Accessed October 2002.] [21]. Szyluk, K., Jasiński, A., Koczy, B., Widuchowski, W., Widuchowski, J. Subacromial impingement syndrome–most frequent reason of the painful shoulder syndrome. Pol Merkur Lekarski. 2008;25(146):179-83.
[22]. Valma, J., Robertson, Kerry, G., Baker. A Review of Therapeutic Ultrasound: Effectiveness Studies, Physical Therapy. 2001;81(7):1339-1350.
[23]. Williamson, M.P., Chandnani, V.P., Baird, D.E., Reeves, T.Q., Deberardino, T.M., Swenson, G.W., Hansen, M.F. Shoulder impingement syndrome: diagnostic accuracy of magnetic resonance imaging and radiographic signs. Australas Radiol. 1994;38(4):265-71.
[24]. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003. CD004258. DOI: 10.1002/14651858.
[25]. Lewis J, Green A, Wright C. Subacromial impingement syndrome: the role of posture and muscle imbalance. Journal of Shoulder and Elbow Surgery. 2005;14(4):385‐92.
[26]. Hsu Y, Chen W, Lin H., et al. The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. J Electromyogr Kinesiol. 2009;19(6): 1092‐1099.
[27]. Miller P, Osmotherly P. Does scapula taping facilitate recovery for shoulder impingement symptoms? A pilot Randomized Controlled Trial. J Man Manipulative Ther. 2009; 17(1):E6‐E13.
[28]. Pappas GP, Blemker SS, Beaulieu CF., et al. In vivo anatomy of the Neer and Hawkins sign positions for shoulder impingement. J Shoulder Elbow Surg. 2006; 15:40‐49.
[29]. Koester MC, George MS, Kuhn JE. Shoulder impingement syndrome” 2015;118(5).
[30]. Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?. British journal of sports medicine. 2009 Apr 1;43(4):259-64.
[31]. Fongemie AE, Buss DD, Rolnick SJ. Management of shoulder impingement syndrome and rotator cuff tears. American family physician. 1998 Feb 15;57(4):667.
[32]. Neer 2nd CS, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. JBJS. 1980 Sep 1;62(6):897-908.
[33]. Oh JH, Kim SH, Kim KH, Oh CH, Gong HS. Modified impingement test can predict the level of pain reduction after rotator cuff repair. The American journal of sports medicine. 2010 Jul;38(7):1383-8.
[34]. Arend CF. Ultrasound of the Shoulder. Master Medical Books, 2013
[35]. Santamato A, Solfrizzi V, Panza F, et al. Randomized clinical trial people with subacromial impingement syndrome: a versus ultrasound therapy in the treatment of short-term effects of high-intensity laser therapy.Phys Ther, 2009;89:643–652.
[36]. Husni EM, Donohue JP.: Painful Shoulder and Reflex Sympathetic Dystrophy Syndrome. Arthritis and Allied Conditions, 15th ed. Philadelphia: Lippincott Williams Wilkins, 2005.
[37]. Robertson VJ, Baker KG.: A review of therapeutic ultrasound: effectiveness studies. Phys Ther, 2001;81:1339–1350.
[38]. Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, Aringer M, Nicolakis P, Wiesinger GF, Baghestanian M, Preisinger E. Ultrasound therapy for calcific tendinitis of the shoulder. New England Journal of Medicine. 1999 May 20;340(20):1533-8.
[39]. Johansson KM, Adolfsson LE, Foldevi MO. Effects of acupuncture versus ultrasound in patients with impingement syndrome: randomized clinical trial. Physical therapy. 2005 Jun 1;85(6):490-501.
[40]. Danicella AWM, Geert JMG. Ultrasound therapy for musculoskeletal disorders, a systematic review. Pain 1999;81:251–271.
[41]. Gursel YK, Ulus Y, Bilgic A, Dincer G, van der Heijden GJ. Adding ultrasound in the management of soft tissue disorders of the shoulder: a randomized placebo-controlled trial. Physical therapy. 2004 Apr 1;84(4):336-43.

Cite this article: Bhargava Shanker, D. Rajesh Reddy, N.S.S.N. Balaji.  Comparison of exercise therapy and ultrasonic therapy in the treatment of shoulder impingement syndrome. Int J Physiother Res 2021;9(3):3825-3833. DOI: 10.16965/ijpr.2021.121