Effectiveness of the manipulative approach associated with a standard program of exercises in relapsing shoulder pain

The treatment involves the education of the patient to the daily execution of specific stretching and strengthening exercises, for a duration of four weeks, the exercises need about 25 minutes daily. Four weeks after enrollment, the patient will suspend the execution of daily exercises. Follow-up is expected one month after suspension, eight weeks after enrollment. The patient will be instructed to perform the exercises by a therapist with at least five years of experience, and will review it once a week to verify the correct execution or adapt it if necessary. To facilitate the execution of the exercises the patient will be provided with dvd and paper support, and a daily diary to note any difficulties on. In the second and fourth weeks the patient of this group will undergo four osteopathic manipulations: joint mobilization of the vertebral level C7 / T1, articular manipulation of the high dorsal levels, manipulation of the dysfunction in superiority of the humerus, manipulation of the dysfunction in anteriority of the humerus. the manipulations will be performed by an osteopath with at least five years of experience. the specific exercises included: upper trapezius stretch, made in sitting position and keeping frontal look; posterior shoulder stretch; pectoralis minor stretch; the exercises will be carried out maintaining the stretching tension for 30 seconds, for ten repetitions. strenghtening of external rotator muscles; strenghtening of lower trapezius; strenghtening of anterior serratus. the exercises will be performed by performing three cycles of 15 contractions with a elastic resistance (like theraband), which will be increased after two weeks. Training and weekly verification of the exercises will be performed by a physiotherapist with at least five years of experience.