The effects of manual therapy, exercise and elastic taping on shoulder pain: A double-blind, randomized clinical trial.

Intervention 1: manual therapy + therapeutic exercise Manual therapy. 10 sessions will be applied by a physiotherapist. One per day. Duration of each session: 15 min. Duration of treatment: 2 weeks. a. 3 sets of 12 repetitions for lower gliding (supine position) and posterior gliding (sitting position) on humeral head, slow velocity and amplitude. b. 3 sets of 12 repetitions for upward scapular rotation (side lying position) Exercise therapy at physiotherapy clinic. 10 sessions (one per day). Duration of each session: 20 min. Total duration: 2 weeks. Comprised of: a. 5 sessions of isometric and isotonic strengthening exercises for scapula stabilizers, rotator cuff muscles and posterior deltoids. From 0 to 45 degrees of abduction. b. 5 sessions of isometric and isotonic strengthening exercises for scapula stabilizers, rotator cuff muscles and posterior deltoids. From 45 to 90 degrees of abduction. c. One session per day during 10 days of stretching exercises for posterior capsula and shoulder internal rotators. 3 repetitions of 30 seconds for each muscular group. Note: manual therapy session (15 min) will be applied firstly, and, afterwards, an exercise therapy session of 20 min, at the same physiotherapy clinic, by the same physiotherapist. Hence, the duration of the session will be 35 min. 10 sessions (see above) will be performed in this way. After that, an extra set of 20 exercise therapy sessions (same exercises as described above) will be prescribed by the physiotherapist for the patient to be done at home, as described below. Exercise therapy at home. 20 sessions (one per day). Duration of each session: 20 min. Total duration: one month. Comprised of: a. Isometric and isotonic strengthening exercises for scapula stabilizers, rotator cuff muscles and posterior deltoids. From 45 to 90 degrees of abduction. b. Stretching exercises for posterior capsula and shoulder internal rotators. 3 repetitions of 30 seconds for each muscular group. In order to monitor the adherence to exercise therapy at home, a participant daily exercise diary will be used. Summary intervention 1: Week 1-2: Manual therapy + Exercise therapy (clinic) Week 3-6: Exercise therapy (Home) Intervention 2: manual therapy + therapeutic exercise + elastic taping Manual therapy: same as intervention 1. Exercise therapy: same as intervention 1. Elastic tape: A single strip will be applied with the subject in erect standing, with the shoulder in maximal external rotation, palm facing forward. The tape was applied from the coracoid process anteriorly to the superior scapular angle posteriorly, to maintain shoulder external rotation. The tape will be stretched to 100% and immediately applied to the skin. Once applied, the adhesion of the tape to the skin was enhanced by rubbing the surface of the tape three times in an anterior to posterior direction. The strip will be maintained during 5 consecutive days and replaced for the next 5 therapy sessions. While wearing elasting taping, manual therapy will be applied and exercises will be executed. The overall duration of the taping application will be 2 weeks. Due to the tape will be worn for 5 consecutive days at the same time as manual therapy is applied, the physiotherapist will check each session that the tape has not been removed. In this case, the old one has been replaced by a new strip. Summary intervention 2: Week 1-2: Manual therapy + Exercise therapy (clinic) + elastic taping Week 3-6: Exercise therapy (Home) Intervention 3: manual therapy + elastic taping Same interventions as intervention 1 and 2 Summary intervention 3: Week 1-2: Manual therapy + Elastic taping (clinic) All the interventions will be carried out in 4 physiotherapy clinics.