Highlights
-
Possibly, achieving improvements in pain, active ROM, and shoulder function does not rely on performing the exercise with or without pain, but other factors could be involved.
- Fourweeks of intervention are sufficient to produce statistically significant improvements in these variables.
Findings
-
The findings suggest that patients with SS could benefit both with a painful exercise protocol and with a pain-free exercise protocol. This could refocus the clinical practice for such patients. However, more research is needed in order to overcome the limitations of this study.
Implications
-
According to the clinical judgment of the authors, future studies with a larger sample size and medium long-term monitoring are needed to confirm the results.
Caution
Abstract
Study Design
Randomized clinical trial.
Introduction
Eccentric exercise (EE) was shown to be an effective treatment in tendinopathies.
However, the evidence of its effectiveness in subacromial syndrome (SS) is scarce.
Moreover, consensus has not been reached on whether best results for SS are obtained
by means of EE with or without pain.
Purpose of the Study
The purpose of this is to compare the effect on pain, active range of motion (AROM),
and shoulder function of an exercise protocol performed with pain <40 mm Visual Analog
Scale (VAS) and without pain, in patients with SS.
Methods
Twenty-two subjects (mean age: 59 years [Q1 = 48.50-Q3 = 70], 54.5% women) were randomized
into a not-painful EE group (NPEE; G0: n = 11) and a painful EE group (PEE; G1: n = 11). The intervention lasted 4 weeks. Pain was recorded using VAS; AROM was measured
using a goniometer; and shoulder function using the modified Constant-Murley Score
(CMS) before and after intervention.
Results
All dependent variables improved significantly in both groups (P < .05): NPEE VAS median: pretest = 55.0 posttest = 28.0; CMS median: pretest = 36.0
posttest = 65.0. PEE VAS median: pretest = 37.0 posttest = 12.0; CMS median: pretest =
35.0 posttest = 59.0. The comparison between groups showed no significant differences,
with small effect size values (VAS = 0.09; CMS = 0.21; AROM = 0.12-0.43).
Discussion
In contrast to the previous findings, our results suggest that PEE do not add benefit
in SS patients compared to NPEE.
Conclusion
Our results suggest that both interventions are effective in terms of pain, function,
and shoulder AROM. Furthermore, PEE does not provide greater benefits. Further studies
are needed with long-term follow-up to reinforce these results.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The dose-response effect of medical exercise therapy on impairment in patients with unilateral longstanding subacromial pain.Open Orthop J. 2010; 4: 1-6
- Does this patient with shoulder pain have Rotator Cuff Disease?.JAMA. 2013; 310: 837
- Palpation tests versus impingement tests in Neer stage I and II subacromial impingement syndrome.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 424-429
- Physiotherapy in patients with clinical signs of shoulder impingement syndrome: A randomized controlled trial.J Rehabil Med. 2013; 45: 488-497
- Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome.Clin Rehabil. 2011; 25: 69-78
- Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series.Rev Bras Fisioter. 2012; 16: 74-83
- Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only.Eur J Phys Rehabil Med. 2013; 49: 499-505
- The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial.Med J Islam Repub Iran. 2014; 87: 28
- Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives.World J Orthop. 2014; 5: 634
- Guideline for diagnosis and treatment of subacromial pain syndrome.Acta Orthop. 2014; 85: 314-322
- Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement.Rev Bras Fisioter. 2009; 13: 1-9
- Results of combined physiotherapy in patients with clinical sings of shoulder impingement syndrome: a randomized controlled trial.JMHM. 2014; 2
- The effectiveness of physiotherapy exercises in subacromial impingement syndrome: A systematic review and meta-analysis.Semin Arthritis Rheum. 2012; 42: 297-316
- Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis.J Electromyogr Kinesiol. 2014; 24: 675-681
- Scapular muscle dysfunction associated with subacromial pain syndrome.J Hand Ther. 2017; 30: 136-146
- Muscle performance during isokinetic concentric and eccentric abduction in subjects with subacromial impingement syndrome.Eur J Appl Physiol. 2010; 109: 389-395
- Factors influencing final outcomes in patients with shoulder pain: A retrospective review.J Hand Ther. 2017; 30: 200-207
- Effects of physiotherapy in patients with shoulder impingement syndrome: A systematic review of the literature.J Rehabil Med. 2009; 41: 870-880
- Effect of isokinetic training on shoulder impingement.Genet Mol Res. 2014; 13: 744-757
- Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.Man Ther. 2015; 20: 646-656
- The demographic and morphological features of Rotator Cuff Disease.J Bone Joint Surg Am. 2006; 88-A: 1699-1704
- Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study.BMJ. 2012; 344: e787
- Eccentric exercises; why do they work, what are the problems and how can we improve them?.Br J Sports Med. 2009; 43: 242-246
- The role of eccentric exercise in sport injuries rehabilitation.Br Med Bull. 2014; 110: 47-75
- Fortalecimiento excéntrico en tendinopatías del manguito de los rotadores asociadas a pinzamiento subacromial. Evidencia actual.Cir Cir. 2015; 83: 74-80
- The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome.J Back Musculoskelet Rehabil. 2011; 24: 173-179
- Clinical tests for the diagnosis of rotator cuff disease.Sports Med Arthrosc. 2011; 19: 266-278
- Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.Cochrane Database Syst Rev. 2008;
- Comparison of eccentric and concentric exercise interventions in adults with subacromial impingement syndrome.Int J Sports Phys Ther. 2015; 10: 441-456
- Eccentric training in chronic painful impingement syndrome of the shoulder: Results of a pilot study.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 76-81
- The measurement of clinical pain intensity: a comparison of six methods.Pain. 1986; 27: 117-126
- Valoración del dolor (I) R E V I S I Ó N.Rev Soc Esp Dolor. 2002; 9: 94-108
- The visual analogue pain intensity scale: What is moderate pain in millimeters?.Pain. 1997; 72: 95-97
- Reliability of shoulder range of motion comparing a goniometer to a digital level.Physiother Theory Pract. 2010; 26: 327-333
- El test de Constant-Murley. Una revisi?n de sus caracter?sticas.Rehabilitación. 2007; 41: 228-235
- The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: a technical report.Physiother Theory Pract. 2012; 28: 161-168
- Intrarater reliability of goniometry and hand-held dynamometry for shoulder and elbow examinations in female team handball athletes and asymptomatic volunteers.Arch Orthop Trauma Surg. 2015; 135: 1719-1726
- Fundamentos de Las Técnicas de Evaluación Musculoesquelética (Bicolor).1a Ed. Paidotribo, 2002 (ISBN: 9788480196574)
- A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res. 1987; 214: 160-164
- Índices Y Escalas Utilizados En Ciertas Tecnologías de La Prestación Ortoprotésica (Portetización Del Sistema Osteoarticular).AETS, 2002 (ISBN/ISSN: 84-95463-14-8)
- Minimal important changes in the Constant-Murley score in patients with subacromial pain.J Shoulder Elbow Surg. 2014; 23: 1083-1090
- Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial.Clin Rheumatol. 2013; 32: 73-85
- Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program.Phys Ther. 2004; 84: 832-848
- Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises.J Athl Train. 2007; 42: 464-469
- Scapular kinematics during supraspinatus rehabilitation exercise: A comparison of full-can versus empty-can techniques.Am J Sports Med. 2006; 34: 644-652
- Exercise modifications and strategies to enhance shoulder function.J Strength Cond Res. 2005; 27: 36
- Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1158-1167
- Serratus anterior muscle activity during selected rehabilitation exercises.Am J Sports Med. 1999; 27: 784-791
- Shoulder kinematics during the wall push-up plus exercise.J Shoulder Elbow Surg. 2010; 19: 216-223
- Effect of a Multi-Air-Cushion Biofeedback Device (MABD) on shoulder muscles during the dynamic hug exercise.J Phys Ther Sci. 2013; 25: 751-752
- Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation.Am J Sports Med. 2008; 36: 1789-1798
- Statistical analysis of ordinal categorical status after therapies.J Consult Clin Psychol. 1994; 62: 281-284
- Review of assumptions and problems in the appropriate conceptualization of effect size.Psychol Methods. 2001; 6: 135-146
- Comparative study of two protocols of eccentric exercise on knee pain and function in athletes with patellar tendinopathy: Randomized controlled study.Rev Bras Med Esporte. 2012; 18: 167-170
JHT Read for Credit
Quiz: #543
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.Outcome measures included
- a.CMS
- b.ROM
- c.VAS score
- d.all of the above
- a.
- #2.The study design was
- a.case study series
- b.retrospective chart reviews
- c.RCTs
- d.large cohort analysis
- a.
- #3.The difference in groups was
- a.the presence or absence of pain when performing the eccentric exercises
- b.the presence or absence of partial thickness tears of the supraspinatus tendon on MRI
- c.the ages of the subjects
- d.the presence or absence of resting pain
- a.
- #4.The exercise regime included
- a.isolated subscapularis strengthening
- b.scapular stabilization
- c.deltoid strengthening
- d.self-mobilization of the glenohumeral joint
- a.
- #5.Neither approach proved better than the other
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: January 09, 2018
Accepted:
November 27,
2017
Received in revised form:
October 23,
2017
Received:
August 4,
2017
Footnotes
The study protocol was approved by the Comisión de Investigación y Ensayos Clínicos del Hospital de Manises (Spain), by the Human Research Committee of the Hospital La Fe (Spain) and by the Human Research Committee of the Universidad de Alcalá (Spain), and registered in Australian New Zealand Clinical Trials Registry (ACTRN12616000196448). The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article.
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Clinical trial registration number: ACTRN12616000196448.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of Hanley & Belfus, an imprint of Elsevier Inc.
