A comparison of manual therapy interventions of the upper back in addressing shoulder impingement syndrome in people over 40 years old.

All intervention is a form of manual therapy performed by an experienced and registered osteopath to participants randomly allocated to one of 3 groups. Arm 1: Sham treatment. Arm 2: Manual therapy to the thoracic spine only. Muscle energy technique (MET) and joint mobilisation will be the only techniques used to the thoracic spine. These techniques are very commonly used osteopathic manual therapy techniques. Both techniques are used in an attempt to increase the range of motion of a joint, in this case, the thoracic spine. Joint mobilisation involves moving one bone of a joint, in this case a vertebrae, with respect to another bone in a joint, another adjacent vertebrae. The movement is small. MET uses joint mobilisation, but once one vertebrae has been moved with respect to another, the practitioner asks the participant to then gently push (contract the appropriate muscles) a body part (for the upper thoracics, the head is usuaully the lever, while for the lower thoracis, the lever can be the trunk or legs) against resistance applied by the practitioner (hence, an isometric contraction) to re-approximate the bones. The practitioner asks for this muscle contraction for between 2 to 5 seconds, then the participant relaxes, at which time the practitioner attempts to increase again the joint range of motion. This can be repeated from 2 to 5 times. All movements by the practitioner are very small and gentle and all muscle contractions by the participant are also gentle. In both joint mobilisation and MET the vertebrae are returned to their original position. Arm3: Manual therapy to the thoracic spine and soft tissue to the rotator cuff. These participants will receive the same treatment as Arm 2 plus soft tissue (massage) techniques to the rotator cuff and posterior scapula muscles of the affected shoulder. The soft tissue techniques will include inhibition, effleurage and cross fibre techniques. In Arm 2 and Arm 3 every technique listed above will be used but it will be up to the practitioner as to how much of each technique will be used. The same registered osteopathic practitioner will be doing every intervention. All interventions will be performed face to face by an experienced and registered osteopath in an established osteopathic clinic. Once participants are deemed eligible, they will be booked in for one intervention session per week for 4 weeks. Participants must attend the first and last session, but the second and third sessions are their choice. They will receive the same intervention each time. Each intervention will take approximately 20-30 minutes. There are no strategies to monitor adherence to the intervention except to book them in to all 4 sessions at their first attendance.