The aim of this study will be to investigate the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM), applied in addition to a conventional exercise program, on pain, range of motion, proprioception, functionality, and quality of life in individuals with Subacromial Impingement Syndrome (SIS).
Individuals diagnosed with SIS by MRI
Men and women between 40 and 60 years of age
Individuals with symptoms persisting for at least one month
Individuals with a minimum of 60° of shoulder flexion and abduction range of motion
Individuals with a history of surgery on the affected arm
Individuals with an open wound on the arm
Individuals with an active infection
Individuals with inflammatory joint disease
Parallel
Conventional exercise group
Other interventionAll participants will receive a standardized electrotherapy program in a clinical setting, consisting of TENS (100 Hz, 30 minutes), ultrasound (1.5 W/cm², 8 minutes), and a 15-minute cold-pack application, delivered three times per week for four weeks. In addition to electrotherapy, participants in the conventional exercise group will perform a physiotherapist-guided exercise program aimed at improving shoulder flexion, abduction, internal and external rotation through stretching and range-of-motion exercises. The program will include Codman exercises, wand exercises, finger-ladder activities, and condition-appropriate strengthening exercises, progressed according to each participant's pain level and tolerance.
IASTM group
Other interventionParticipants in the IASTM group will receive Instrument-Assisted Soft Tissue Mobilization in addition to the conventional treatment program, three days per week for four weeks, for a total of 12 sessions. The IASTM technique will be applied to the subscapularis, anterior deltoid, biceps brachii, upper trapezius, supraspinatus, infraspinatus, teres major, teres minor, and posterior deltoid muscles. For each muscle group, the treatment will be administered for 20 seconds in a parallel direction and 20 seconds in a perpendicular direction, using sweep and brush techniques at an angle of approximately 45 degrees.
Visual Analog Scale
The Visual Analog Scale (VAS) is a tool used to measure pain intensity as a single-dimensional construct across different adult populations. It typically consists of a horizontal or vertical line measuring 10 cm in length. On this scale, a score of 0 indicates no pain, while a score of 10 represents the worst pain imaginable.
Range of motion
Shoulder flexion, abduction, internal rotation, and external rotation range of motion will be assessed using a universal goniometer while the patient is positioned in supine and performs the movements actively.
The Disabilities of the Arm, Shoulder and Hand (DASH)
The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a scale that evaluates functional status and capability following injuries or disorders affecting the upper extremity. The DASH consists of 30 items. These items assess difficulties encountered during specific tasks, as well as pain, numbness, stiffness, weakness, sleep problems, self-confidence, and participation in social activities. Scores range from 0 to 100, with higher scores indicating greater impairment in upper extremity function.
Joint position sense
To evaluate shoulder proprioception, joint position sense will be measured at 60° of shoulder flexion and 60° of shoulder abduction. During the assessment, participants will be positioned in standing and guided to the target angles by the physiotherapist using a goniometer. In each position, participants will be asked to maintain 60° of flexion or 60° of abduction for 10 seconds with their eyes open and to memorize the perceived position. They will then be instructed to reproduce the same movement with their eyes closed. The difference between the angle measured with eyes open and the angle reproduced with eyes closed will be recorded as the joint position sense error (error angle).
Rotator cuff quality of life Index
Quality of life in individuals with shoulder pathology was evaluated using the Rotator Cuff Quality of Life (RC-QoL) questionnaire. The RC-QoL consists of 34 items and five subscales. Results are interpreted in a positive direction; as the RC-QoL score increases, the individual's shoulder-related quality of life is considered to have improved, and symptoms are regarded as reduced.
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