COMPARISON OF ACTIVE RELEASE TECHNIQUE AND KALTENBORN–EVJENTH ORTHOPEDIC MANUAL THERAPY ON PAIN, RANGE OF MOTION, AND FUNCTIONAL DISABILITY IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME

Abstract

Background: Subacromial pain syndrome (SIS), or shoulder impingement syndrome, is one of the most common shoulder diseases and leads to pain, loss of range of motion (ROM), and functional disability. Although exercise therapy is the most important in the conservative management, manual therapies, used as adjunctions, might speed up healing. Active Release Technique (ART) and Kaltenborn-Evjenth Orthopedic Manual Therapy (KEOMT) are two different mechanistic therapy approaches, namely soft tissue mobilization and joint mobilization, respectively, but their relative efficacy in SIS has not been established.

Aim: To determine the short-term efficacy of ART and KEOMT, along with a standardized exercise regimen, on pain, ROM, and functional disability in SIS patients.

Methods: A randomized controlled trial was performed with 60 clinically diagnosed SIS participants (aged 18-60 years); it was a single-blinded study. The participants were randomly divided into two groups; Group A was receiving ART, and Group B was receiving KEOMT with three sessions every week over a period of six weeks under the same exercise therapy. The main outcomes were pain intensity (Visual Analog Scale, VAS), shoulder ROM (flexion, abduction, and internal and external rotation with the goniometer), and functional disability (Shoulder Pain and Disability Index, SPADI). Measurements were done at baseline, week 3, and post-intervention (week 6).

Results: Both conditions showed large within-group changes in all outcomes. ART was found to have larger pain (VAS: pre 6.7-post 2.1 vs. KEOMT pre 6.5-post 3.0, p < 0.05) and functional disability (SPADI: 72.5%-22.6% vs. 70.8%-33.4%, p = 0.01) reductions. KEOMT, on the other hand, demonstrated a better improvement of ROM, especially in flexion (148° vs. 158°) and abduction (151° vs. 164°, p < 0.05).

Conclusion: ART is superior in enhancing pain and functional improvement rapidly, whereas KEOMT provides more significant improvements with respect to shoulder ROM. Both modalities are suitable to supplement exercise therapy, although their use can be optimized on the basis of patient clinical profile—pain and disability versus motion restriction. Stratified rehabilitation strategies for SIS need to be refined so that future multicenter trials with larger cohorts and extended follow-up are justified.