An interventional study of Percussion massage therapy device and Instrument-assisted soft tissue mobilization device in Impingement Syndrome, Impingement Shoulder and Shoulder Pain, sponsored by Emre DANSUK. Completed at 1 site in Turkey (Türkiye). Open to participants aged 40 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-07-24.
Sponsored by Emre DANSUK · Not applicable, Interventional, and Treatment
This assessor-blinded, three-arm, parallel-group randomized controlled trial investigated the additional effects of percussion massage therapy and instrument-assisted soft tissue mobilization in individuals with subacromial impingement syndrome. Forty-eight participants aged 40-60 years with clinically and magnetic resonance imaging-confirmed subacromial impingement syndrome were randomly allocated in a 1:1:1 ratio to conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.
All groups received a standardized four-week conventional physiotherapy programme. Participants in the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received their respective interventions three times per week for four weeks. Outcomes were evaluated at baseline and immediately after the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes were shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.
Subacromial impingement syndrome is commonly associated with shoulder pain, limitations in range of motion, functional disability, and impaired sensorimotor control. Exercise-based rehabilitation is considered a primary component of conservative management. Percussion massage therapy and instrument-assisted soft tissue mobilization are frequently used as adjunct soft-tissue interventions; however, comparative evidence regarding their additional effects in individuals with subacromial impingement syndrome remains limited.
This study was designed as a parallel-group, assessor-blinded randomized controlled trial with a 1:1:1 allocation ratio. Forty-eight eligible participants were randomly allocated to one of three groups: conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.
The randomization sequence was computer-generated using Randomizer.org by an independent researcher who was not involved in participant recruitment, intervention delivery, or outcome assessment. Because of the nature of the interventions, participants and treating physiotherapists could not be blinded. Outcome assessments were conducted by an independent physiotherapist blinded to group allocation. Statistical analyses were conducted by a biostatistician blinded to coded group assignments.
All participants received a standardized conventional physiotherapy programme for four weeks. Participants assigned to the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received the corresponding soft-tissue intervention three times per week for four weeks.
Outcome assessments were performed at baseline and immediately after completion of the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes included shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.
Exclusion Criteria:
Participants received the standardized conventional physiotherapy programme for four weeks and additionally received percussion massage therapy three times per week for four weeks.
Device: Percussion massage therapy device · Other: Conventional Physiotherapy
Participants received the standardized conventional physiotherapy programme for four weeks and additionally received instrument-assisted soft tissue mobilization three times per week for four weeks.
Device: Instrument-assisted soft tissue mobilization device · Other: Conventional Physiotherapy
Participants received a standardized, supervised conventional physiotherapy programme five sessions per week for four weeks.
Other: Conventional Physiotherapy
Percussion massage therapy was administered using a handheld Hypervolt device (Hyperice, California, USA) at 33 Hz, corresponding to level 2 of the device. A flat-head attachment was used to provide uniform contact with the treated tissues. The intervention was applied to the deltoid, supraspinatus, infraspinatus, and teres minor muscles along their anatomical fibre orientation. Each muscle was treated for three minutes using controlled longitudinal strokes applied alternately in proximal-to-distal and distal-to-proximal directions. The intervention was administered by the same licensed physiotherapist three times per week for four weeks, concurrently with the conventional physiotherapy programme.
Also known as: Hypervolt Percussion Massage Device
Instrument-assisted soft tissue mobilization was administered to the deltoid, supraspinatus, infraspinatus, and teres minor muscles three times per week for four weeks. All applications were performed by the same licensed physiotherapist. Standardized sweep and brush stroke techniques were applied at an approximate treatment angle of 45 degrees and in accordance with the anatomical fibre orientation of each muscle. For each muscle, 20 seconds of parallel strokes were followed by 20 seconds of perpendicular strokes using controlled sweeping movements. The intervention was provided in addition to the conventional physiotherapy programme.
Also known as: IASTM
Participants received a standardized, supervised conventional physiotherapy programme for four weeks, administered five sessions per week by a licensed physiotherapist. Each session included transcutaneous electrical nerve stimulation applied to the symptomatic shoulder for 20 minutes at 100 Hz, followed by a structured exercise programme. The exercise programme included wand-assisted active range-of-motion exercises for shoulder flexion, abduction, extension, internal rotation, and external rotation; Codman pendulum exercises; active and passive stretching; and finger ladder exercises. Progressive strengthening exercises using elastic resistance bands were performed for shoulder flexion, abduction, internal rotation, external rotation, and extension. Resistance was progressively adjusted according to pain severity, functional capacity, and treatment tolerance, while a standardized volume of 10 repetitions per set was maintained.
Change in Shoulder Joint Position Sense Error
Shoulder joint position sense was assessed using a digital goniometer at target positions of 60 degrees of shoulder flexion and 60 degrees of shoulder abduction. The affected shoulder was passively positioned at the target angle, and the participant was allowed up to 10 seconds to memorize the position. The arm was then returned to the neutral position, and the participant was asked to actively reproduce the target position with the eyes closed. The absolute angular difference between the target position and the reproduced position was calculated in degrees. Three trials were conducted for flexion and three trials for abduction, and the mean absolute error for each direction was used in the analysis. Lower values indicate greater joint position sense accuracy.
Time frame: Baseline and immediately after the 4-week intervention
Change in Shoulder Range of Motion
Active shoulder range of motion was measured in degrees using a digital goniometer under standardized assessment conditions. Shoulder flexion, abduction, internal rotation, and external rotation were assessed. Higher values represent greater shoulder range of motion.
Time frame: Baseline and immediately after the 4-week intervention
Change in Resting and Activity-Related Shoulder Pain
Resting and activity-related shoulder pain intensity were assessed separately using a 10-centimetre Visual Analog Scale. The scale was anchored by 0, indicating no pain, and 10, indicating the worst imaginable pain. Participants marked their pain intensity on the scale, and the distance from the zero anchor was measured in centimetres. Lower scores indicate lower pain intensity.
Time frame: Baseline and immediately after the 4-week intervention
Change in Upper-Extremity Disability
Upper-extremity disability was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire. The questionnaire contains 30 items and generates a total score ranging from 0 to 100. Higher scores indicate greater upper-extremity disability, whereas lower scores indicate better function.
Time frame: Baseline and immediately after the 4-week intervention
Change in Rotator Cuff-Related Quality of Life
Rotator cuff-related quality of life was assessed using the Rotator Cuff Quality of Life questionnaire. The questionnaire contains 34 items covering physical symptoms, work, daily activities, social functioning, and emotional well-being. Scores are expressed on a scale from 0 to 100, with higher scores indicating better rotator cuff-related quality of life.
Time frame: Baseline and immediately after the 4-week intervention
Plan to share: Yes — De-identified individual participant data underlying the results reported in the published article will be made available upon reasonable request to the corresponding author for scientifically sound research purposes. Data access will be subject to approval of the proposed use and completion of an appropriate data-sharing agreement, in accordance with institutional policies and applicable ethical requirements.
Supporting information: Study protocol
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