Progressive high-load strength training compared with general low-load exercises in patients with rotator cuff tendinopathy: study protocol for a randomised controlled trial (original) (raw)
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Orthopaedic journal of sports medicine, 2017
Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated. To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy. Randomized controlled trial; Level of evidence, 1. Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population. A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically...
journal biology of exercise, 2014
the aim of this pilot trial was to study the effectiveness of an exercise programme in the treatment of chronic rotator cuff tendinopathy. patients were allocated to two groups by sequential allocation. the patients in group a (n=10) received an exercise programme consisted of slow progressive isotonic, including eccentric, strengthening exercises and static stretching exercises. the exercise programme was given daily (apart from weekends) for 4 weeks. the patients in the group B (placebo group, n=10) received placebo tablets (unmarked vitamin C) twice daily for four weeks. patients' pain was evaluated using a visual analogue scale (VaS) at the end of the four-week course of treatment (week 4) and three months after the end of treatment (week 16). Differences between groups were determined using the independent t test. the difference within groups between baseline and end of treatment was analysed with a paired t test. at the end of treatment there was a decline in visual analogue scale of about 7 units in the exercise programme group compared with baseline (p<0.0005,paired t test). there were significant differences in the magnitude of reduction between the groups at the end of treatment and at the three month follow up (p >0.0005, independent t test) in favour of the exercise programme group. although the pain reduced in patients with shoulder tendinopathy at the end of the treatment using an exercise programme, future controlled studies are needed to establish the effectiveness of an exercise programme in the treatment of rotator cuff tendinopthy.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2016
To investigate the effectiveness of isolated eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy. Thirty-six patients with rotator cuff tendinopathy, diagnosed by an orthopaedic surgeon, were included and randomly allocated to an isolated eccentric exercise (EE) group (n = 20, mean age = 50.2 ± 10.8 years) or a conventional exercise (CG) group (n = 16, mean age = 48.6 ± 12.3 years). Both groups fulfilled a 12-week daily home-based exercise programme and received a total amount of nine treatment sessions. The Constant Murley score was used to evaluate both objective (e.g. range of motion and strength) and subjective measures (e.g. pain and activities of daily living). A visual analogue scale (VAS) was used to evaluate pain during daily activities. As secondary outcomes, shoulder range of motion and isometric abduction strength in 45° in the scapular plane were evaluated. All measurements were taken at baseline, at 6, 12 and 26 weeks. After 26 wee...
Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives
World journal of orthopedics, 2014
Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder...
Effects of eccentric exercises on tendinopathy of the shoulder rotator cuff: A systematic review
Introduction:Rotator cuff injuries are among the main causes of joint pain and disfunction. Eccentric exercise is commonly used in tendinopathies.Objective:To evaluate the effects of administering eccentric exercises on the rehabilitation of rotator cuff tendinopathy.Material and Method: This is a systematic review based on randomized clinical trials found in Pubmed/MEDLINE, Science Direct, PEDro and Cochrane Library databases, published in all languages with adult patients, aged 18 to 80 years, presenting signs and symptoms suggestive of rotator cuff tendinopathy. Results: Eccentric exercises have been shown to be effective in the treatment of rotator cuff tendinopathy, however, they are not relevant when compared to other exercise modalities.
2020
Background Underlying muscle weakness may explain the inconsistency in the development of rotator cuff tendinopathy in population with similar activity levels. This systematic review aims to assess existing prospective studies to evaluate whether muscle weakness is a risk factor to the development of rotator cuff tendinopathy. Methods A systematic search was performed using the PRISMA guidelines. Prospective studies measuring muscle strength or stiffness and the incidence of rotator cuff tendinopathy will be included. Quality assessment was performed with the Newcastle-Ottawa Quality Assessment Scale. Results The search yielded 6 studies, with a total of 523 trained overhead athletes followed up for 1 season. External and internal rotation strength was described as protective factors for the development of rotator cuff tendinopathy, with an odds ratio of 0.940 (p < 0.05) and 0.946 (p < 0.01) respectively for each N/m increased in force generated. Limited range of motion of <106 o for shoulder external rotation was also described as a risk factor with an odds ratio of 1.12 (p < 0.001). Imbalance between external and internal rotation strength was reported as a risk factor for shoulder injuries in 2 studies, with a relative risk of 2.57 (p < 0.05) reported in 1 of them. Supraspinatus weakness was also reported as a risk factor for shoulder injuries in 1 study, with no odds ratio or relative risk provided. Due to insu cient data, combination into a meta-analysis was not possible. Conclusions Limited evidence support that weakness of the external rotators, weakness in the internal rotators, and limited range of motion in external rotation are risk factors to the development of rotator cuff tendinopathy. Very limited evidence support that imbalance in external rotator and internal rotator strength, and supraspinatus weakness are risk factors for rotator cuff tendinopathies. Future cohort studies may improve on existing evidence with investigations on more muscle groups, a longer follow-up time, clearly documented injury history, and a stringent diagnosis to rotator cuff tendinopathy. Background Rotator cuff tendinopathy is an umbrella term describing pain and loss of function in the rotator cuff tendon. Entities including tendinosis, tendinitis, subacromial impingement, subacromial bursitis are often regarded under the term rotator cuff tendinopathy.(1) As reported in previous studies, rotator cuff tendinopathy affects more than 50% of the population over the age of 60, contributing to the loss of function and poor quality of life.(2) As a consequence, rotator cuff tendinopathy also leads to large socioeconomical impacts.(3) The pathogenesis of tendinopathy is believed to involve a failed healing process, of which etiology is multifactorial(4). Overload or overuse of the rotator cuff tendons was suggested to be one of the factors leading to the development of rotator cuff tendinopathy. To explain the association of tendinopathy with overuse, previous studies have demonstrated that tendon loading, in terms of compression or tensile loads, would induce apoptosis and in ammation to tendon cells.(5,6) An increased activity level would increase tendon loading. However, the fact that athletes with similar training load present inconsistently with tendinopathy suggest that some factors may play a role in the modulation of tendon loading under given training load. Muscle weakness may be a factor modulating tendon loading. It is a relative term referring to the failure to generate a desired or expected force.(7) The mechanism of how weakness in rotator cuff muscles may lead to rotator cuff tendinopathies has been hypothesized by multiple groups. As suggested by previous studies, rotator cuff muscles prevent humeral head elevation, which will decrease the size of subacromial space and increase the risk of supraspinatus impingement.(8),(9) The reduction of subacromial space in patients with rotator cuff tendinopathy was also demonstrated by a previous retrospective study.(10) Another study suggested that external rotation strength is crucial for the deceleration of arm swinging movements.(11) Its weakness in athletes with repetitive forceful arm swings is hypothesized lead to strains and tears to the tendon.(12) Muscle stiffness was also suggested to lead to weaken muscles via reciprocal inhibition from a tight antagonist(8). The stiffness of upper trapezius muscles was demonstrated in patients with rotator cuff tendinopathy in a previous retrospective study(13). There is a possibility that muscle stiffness of the shoulder may be one of the causes leading to muscle weakness and the development of rotator cuff tendinopathies. In summary, expert opinions have suggested that muscle weakness and stiffness may lead to an increased risk of the development of tendinopathies.(14,15) This suggestion has been supported by several authors reviewing retrospective and cadaveric studies.(10,16-19) However, as these parameters are readily in uenced by the presence of pain, the association between muscle imbalance and the development of tendinopathy is yet to be established. Purpose of this review This review aims to examine existing prospective studies on identifying the association between muscle weakness and rotator cuff tendinopathy. Muscle weakness would be identi ed by direct measurements of muscle strength, while associated factors like muscle stiffness may suggest a cause to the 20 De cit 21 Strength 22 Stiffness 23 Flexibility 24 Range of Motion 25 18 OR 19 OR 20 OR 21 OR 22 OR 23 OR 24 26 3 AND 17 AND 25 restricted to English language, full text, human studies Eligibility criteria Clinical studies were included if ALL the followings are met (i) prospective data containing the measurement of muscle strength or muscle stiffness were documented. (ii) Incidence of tendinopathy was documented. (iii) Patients were described to have rotator cuff tendinopathy / tendinosis / tendinitis / tear, or subacromial impingement / bursitis. A study was excluded if (i) patients were treated with any interventions, and (ii) the study was an animal study. Study selection and data collection Studies from the systematic search were merged in EndNote X9 (Thomson, New York), with duplicates removed. Application of exclusion and inclusion criteria was performed by screening the titles and abstracts, followed by retrieval of full texts of included studies. Two reviewers (CKK and MCK) independently screened all the titles and abstracts, and reviewed the identi ed studies for inclusion. Disagreements were resolved by consensus between 2 reviewers. A third reviewer (FSC) was available to resolve further disagreements. A PRISMA-owchart of the selection process is shown in Fig. 1.
BMJ Open, 2017
Introduction: Rotator cuff tendinopathy (RCTe) is the most frequent cause of shoulder pain, resulting in considerable losses to society and public resources. Muscle imbalance and inadequate sensorimotor control are deficits often associated with RCTe. Kinesiotaping (KT) is widely used by clinicians for rehabilitation of RCTe. While previous studies have examined the immediate effects of KT on shoulder injuries or the effects of KT as an isolated method of treatment, no published study has addressed its mid- and long-term effects when combined to a rehabilitation program for patients with RCTe. The primary objective of this randomised controlled trial (RCT) will be to assess the efficacy of therapeutic KT, added to a rehabilitation program, in reducing pain and disabilities in individuals with RCTe. Secondary objectives will look at the effects of KT on the underlying factors involved in shoulder control, such as muscular activity, acromiohumeral distance (AHD), and range of motion (ROM). Methods and analysis: A single-blind RCT will be conducted. Fifty-two participants, randomly allocated to one of two groups (KT or no-KT), will take part in a 6-week rehabilitation program. The KT-group will receive KT added to the rehabilitation program, whereas the no-KT group will receive only the rehabilitation program. Measurements will be taken at baseline, week-3, week-6, week-12 and 6-months. Primary outcomes will be symptoms and functional limitations assessed by the DASH questionnaire. Secondary outcomes will include shoulder ROM, AHD at rest and at 60º of abduction, and muscle activation during arm elevation. The added effects of KT will be assessed through a 2-way ANOVA for repeated measures. Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of Quebec Rehabilitation Institute (IRDPQ) of the Center Integrated University Health and Social Services (CIUSSS-CN). Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations. Trial registration number: Protocol registered at ClinicalTrials.gov (NCT02881021) on August 25, 2016. The World Health Organization Trial Registration Data Set can also be found as a supplementary file. Keywords: elastic tape, kinesiology taping, physiotherapy, rotator cuff, shoulder pain, tendon injuries.
International journal of sports physical therapy, 2016
While physical therapy is an effective element in the rehabilitation of rotator cuff (RC) disease, the most effective sequence of exercise training interventions has not been defined. The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises. Level I randomized crossover trial. This was a prospective study of 26 men and 14 women with a mean age 51 who were diagnosed with subacromial impingement syndrome (SAIS). They were randomly assigned to one of two groups for a comprehensive and standardized rehabilitation program over six visits at an orthopedic outpatient clinic. One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation. The results showed significa...