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This study investigates whether adding cervical mobilization to shoulder mobilization improves pain, sensation, and function in subacromial impingement syndrome.

June 4, 2026BMC Musculoskeletal Disorders0 citationsOpen Access

Does adding cervical mobilization to shoulder mobilization improve pain, sensation, and function in subacromial impingement syndrome? A three-arm randomized controlled trial

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Key Points

This study investigates whether adding cervical mobilization to shoulder mobilization improves pain, sensation, and function in subacromial impingement syndrome.
Randomly allocated 45 participants into three groups: conventional treatment, shoulder mobilization, and cervical mobilization (n=15 each).
Performed a 15-session treatment program with assessments using VAS, PPT, tactile sensation tests, ROM, and DASH questionnaire before and after intervention.
Study registered at ClinicalTrials.gov (NCT06602206).
Cervical mobilization group showed significantly greater reduction in VAS scores (F=5.251, p=0.009).
Pain-free ROM improved significantly in the cervical group (F=3.501, p=0.039).
Both mobilization groups had better DASH scores than controls (F=3.933, p=0.027).

Abstract

The impact of adding cervical mobilization in Subacromial Impingement Syndrome (SIS) remains underexplored. This study investigated the effects of adding cervical to shoulder mobilization on pain, sensation, and function in patients with Subacromial Impingement Syndrome. The study was registered at ClinicalTrials.gov (NCT06602206) on 30/07/2024. Participants (n = 45, aged 27–65) were randomly allocated into three groups (n = 15 each): a conventional treatment group (6 males, 9 females), a shoulder mobilization group (6 males, 9 females), and a cervical mobilization group (5 males, 10 females). Pain was assessed using the visual analog scale (VAS), pressure pain threshold (PPT) with a handheld dynamometer, tactile sensation with a two-point discrimination test using an esthesiometer, range of motion (ROM) and pain-free ROM with a goniometer, and functional status with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. All participants underwent a 15-session treatment program. Assessments were conducted before and after the intervention. All groups improved in pain, ROM, sensation, and function (p < 0.05). The cervical mobilization group showed a greater reduction in VAS scores than the others (F = 5.251, p = 0.009). Pain-free ROM improved most in the cervical and least in the control group (F = 3.501, p = 0.039). PPT and tactile sensation increased significantly in the cervical group (F = 3.256, p = 0.048; F = 3.529, p = 0.038). Both mobilization groups improved more in DASH scores than controls (F = 3.933, p = 0.027). All outcomes had large effect sizes. While all interventions were beneficial in SIS, cervical mobilization combined with conventional treatment and shoulder mobilization proved most effective in reducing pain, enhancing pain-free ROM, and improving sensory function. Minimal Clinically Important Differences values were established for all assessment tools. This study used a three-arm design to assess treatments for subacromial impingement. First to report MCID for pain-free arc, ROM, and sensation providing novel references. First to show cervical plus shoulder mobilization improves tactile sensation in SIS. Shoulder plus cervical mobilization reduced pain, improved pain-free arc & sensation in SIS.

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