Use of mobilization with movement in the treatment of a patient with subacromial impingement: A case report

Mobilization with movement (MWM) is a fairly new therapeutic technique commonly used by physical therapists. The purpose of this case report was to describe the use of MWM in the treatment of a 27-year old left-hand dominant male patient referred to physical therapy with a diagnosis of supraspinatus tendinopathy secondary to impingement. Interventions consisted of MWM and other manual therapy techniques, modalities, and therapeutic exercises. Outcome measures used included goniometric active range of motion (AROM) measurements and manual muscle tests of the shoulder, impingement tests, and the Shoulder Pain and Disability Index (SPADI) and Short Form-36 (SF-36) questionnaires. Specific outcome measures used to describe the response to MWM of the glenohumeral joint included the Numeric Pain Rating Scale (NPRS) and goniometric measurement of abduction AROM. After the first MWM treatment (session 2/12), the 6/10 pre-application NPRS score during shoulder abduction was reduced to 3/10 post-application; however, abduction AROM did not improve (95°). At the final MWM treatment (session 6/12), the pre-application NPRS score during abduction was reduced from 3/10 to 0/10 post-application: abduction AROM increased from 130° to 175°. After 12 sessions, there was a decrease from moderate pain (7/10) to little or no pain (0-1/10) during active shoulder abduction; restricted (95°) to full shoulder abduction active range of motion (180°); and an improvement in the SPADI score from 45% to 8% with no pain or ADL activity difficulty scores >2. This case report indicates that MWM may be an effective treatment intervention for patients with subacromial impingement. Future research is needed to study the efficacy and mechanisms of this treatment technique.