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Table 1 Physiotherapy intervention components

From: Dry needling in a manual physiotherapy and therapeutic exercise protocol for patients with chronic mechanical shoulder pain of unspecific origin: a protocol for a randomized control trial

Treatment section Dose
MTrP pressure realease technique
On the most hyperalgesic point of the infraspinatus, upper trapezius, middle deltoids and subscapularis muscles. If there is no MTrP, the technique will be not applied to that muscle.
Twice on each point to be treated during 60 s and a 15 s rest.
Longitudinal massage
Slow and deep massage along the muscle band of the hyperalgesic point treated above, with a tolerable pressure for the participant. If there is no hyperalgesic point, it will be applied to the entire muscle.
3 longitudinal sweeps across each taut band found, with an approximate duration of 20 s per sweep.
Scapular-humeral mobilizations
Passive movements of ascent and descent, abduction and adduction, internal and external scapular rotation, scapular distraction movements and scapular circumduction of the affected shoulder.
10 repetitions of each movement, in the absence of pain or only slight discomfort tolerated by the participant. Participant in lateral decubitus of the healthy side.
Glenohumeral joint mobilizations
Anterior and posterior passive movements of the glenohumeral joint. For the treatment position, the shoulder will be previously placed in passive abduction to end of ROM without pain.
2 sets of 20 anterior and posterior mobilizations. Participant supine.
Glenohumeral gapping and gliding
Passive shoulder abduction to end range without pain. Subsequently, a technique of caudal gapping and gliding of the glenohumeral joint will be performed.
3 sets of 15 repetitions. Participant supine.
Mobilizations with active movement
Slow and controlled active shoulder flexion movement to end range without pain. During the active movement, the physiotherapist will secure the scapula and will perform a posterolateral thrust on the humeral head.
3 sets of 5 repetitions in a sitting position. If there is pain, will find a plane of motion without pain or will change the position of the supporting hands.
Therapeutic exercise
Performed during the treatment sessions and at home in 3 progressive stages, each lasting 2 weeks.
Sessions; once/week, 25 min with the physiotherapist’s supervision.
At home; twice/week, 20 min.