Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2022 | Subacromiales Impingement | Research

Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial

Authors: Pierre Schydlowsky, Marcin Szkudlarek, Ole Rintek Madsen

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested.

The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR.

Methods

Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430.

Results

CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference.

Conclusion

We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.

van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54:959–64. https://doi.org/10.1136/ard.54.12.959.CrossRefPubMedPubMedCentral

Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51:642–51. https://doi.org/10.1002/art.20535.CrossRefPubMed

Perry SM, Getz CL, Soslowsky LJ. After rotator cuff tears, the remaining (intact) tendons are mechanically altered. J Shoulder Elb Surg. 2009;18:52–7. https://doi.org/10.1016/j.jse.2008.07.003.CrossRef

Haahr JP, Østergaard S, Dalsgaard J, Norup K, Frost P, Lausen S, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow-up. Ann Rheum Dis. 2005;64:760–4. https://doi.org/10.1136/ard.2004.021188.CrossRefPubMedPubMedCentral

Ludewig PM, Borstad JD. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med. 2003;60:841–9. https://doi.org/10.1136/oem.60.11.841.CrossRefPubMedPubMedCentral

Liaghat B, Ussing A, Petersen BM, Andersen HK, Barfod KW, Jensen MB, Hoegh M, Tarp S, Juul-Kristensen B, Brorson S. Supervised training compared with no training or self-training in patients with subacromial pain syndrome: a systematic review and Meta-analysis. Arch Phys med Rehabil. 2021;28:S0003-9993(21)00318-X. doi: https://doi.org/10.1016/j.apmr.2021.03.027. Online ahead of print.

Gutiérrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C, Álvarez-Bueno C, Martínez-Vizcaíno V, Cavero-Redondo I. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: a systematic review and meta-analysis. Phys Ther Sport. 2020;41:34–42. https://doi.org/10.1016/j.ptsp.2019.11.003 Epub 2019 Nov 6.CrossRefPubMed

Larsson R, Bernhardsson S, Nordeman L. Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):446. https://doi.org/10.1186/s12891-019-2796-5.CrossRefPubMedPubMedCentral

Kuhn JE. Exercise in the treatment of rotatorcuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elb Surg. 2009;18:138–60. https://doi.org/10.1016/j.jse.2008.06.004.CrossRef

10.

Björnsson Hallgren HC, Adolfsson LE, Johansson K, Öberg B, Peterson A, Holmgren TM. Specific exercises for subacromial pain. Acta Orthop. 2017;88:600–5. https://doi.org/10.1080/17453674.2017.1364069.CrossRefPubMedPubMedCentral

11.

Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012;20(344):e787. https://doi.org/10.1136/bmj.e787.CrossRef

12.

Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007;35:1744–51. https://doi.org/10.1177/0363546507303560.CrossRefPubMed

13.

Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48:692–7. https://doi.org/10.1136/bjsports-2013-092148.CrossRefPubMed

14.

Michener LA, Sharma S, Cools AM, Timmons MK. Relative scapular muscle activity ratios are altered in subacromial pain syndrome. J Shoulder Elb Surg. 2016;25:1861–7. https://doi.org/10.1016/j.jse.2016.04.010.CrossRef

15.

Maenhout A, Van Eessel V, Van Dyck L, Vanraes A, Cools A. Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Am J Sports Med. 2012;40:2105–12. https://doi.org/10.1177/0363546512454530.CrossRefPubMed

16.

Tyler TF, Nicholas SJ, Lee SJ, Mullaney M, McHugh MP. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010;38:114–9. https://doi.org/10.1177/0363546509346050.CrossRefPubMed

17.

Desmeules F, Boudreault J, Dionne CE, Frémont P, Lowry V, MacDermid JC, et al. Efficacy of exercise therapy in workers with rotator cuff tendinopathy: a systematic review. J Occup Health. 2016;58:389–403. https://doi.org/10.1539/joh.15-0103-RA.CrossRefPubMedPubMedCentral

18.

Tahran Ö, Yeşilyaprak SS. Effects of modified posterior shoulder stretching exercises on shoulder mobility, pain, and dysfunction in patients with subacromial impingement syndrome. Sports Health. 2020;12:139–48. https://doi.org/10.1177/1941738119900532 Epub 2020 Feb 4.CrossRefPubMedPubMedCentral

19.

Turgut E, Duzgun I, Baltaci G. Stretching exercises for subacromial impingement syndrome: effects of 6-week program on shoulder tightness, pain, and disability status. J Sport Rehabil. 2018;27:132–7. https://doi.org/10.1123/jsr.2016-0182 Epub 2018 Mar 8.CrossRefPubMed

20.

Gutiérrez-Espinoza H, Araya-Quintanilla F, Gutiérrez-Monclus R, Ríos-Riquelme M, Álvarez-Bueno C, Martínez-Vizcaino V, et al. Does pectoralis minor stretching provide additional benefit over an exercise program in participants with subacromial pain syndrome? A randomized controlled trial. Musculoskelet Sci Pract. 2019;44:102052. https://doi.org/10.1016/j.msksp.2019.102052 Epub 2019 Aug 25.CrossRefPubMed

21.

Kongsgaard M, Kovanen V, Aagaard P, Doessing S, Hansen P, Laursen AH, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19:790–802. https://doi.org/10.1111/j.1600-0838.2009.00949.x.CrossRefPubMed

22.

Eriksen CS, Svensson RB, Gylling AT, Couppé C, Magnusson SP, Kjaer M. Load magnitude affects patellar tendon mechanical properties but not collagen or collagen cross-linking after long-term strength training in older adults. BMC Geriatr. 2019;19:30. https://doi.org/10.1186/s12877-019-1043-0.CrossRefPubMedPubMedCentral

23.

Moseley JB Jr, Jobe FW, Pink M, Perry J, Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20:128–34. https://doi.org/10.1177/036354659202000206.CrossRefPubMed

24.

Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of clinical tests for subacromial impingement syndrome. Arch Phys Med Rehab. 2009;90:1898–903. https://doi.org/10.1016/j.apmr.2009.05.015.CrossRef

25.

Conroy DE, Hayes KW. The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther. 1998;28:3–14. https://doi.org/10.2519/jospt.1998.28.1.3.CrossRefPubMed

26.

Walther M, Werner A, Stahlschmidt T, Woelfel R, Gohlke F. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study. J Shoulder Elb Surg. 2004;13:417–23. https://doi.org/10.1016/j.jse.2004.02.002.CrossRef

27.

Ellsworth AA, Mullaney M, Tyler TF, Malachy McHugh M, Nicholas S. Electromyography of selected shoulder musculature during un-weighted and weighted pendulum exercises. N Am J Sports Phys Ther. 2006;1:73–9.PubMedPubMedCentral

28.

Murphy CA, McDermott WJ, Petersen RK, Johnson SE, Baxter SA. Electromyographic analysis of the rotator cuff in postoperative shoulder patients during passive rehabilitation exercise. J Shoulder Elb Surg. 2013;22:102–7. https://doi.org/10.1016/j.jse.2012.01.021 Epub 2012 May 3.CrossRef

29.

Cunningham G, Charbonnier C, Lädermann A, Chagué S, Sonnabend DH. Shoulder motion analysis during Codman pendulum exercises. Arthrosc Sports Med Rehabil. 2020;(2):e333–9. https://doi.org/10.1016/j.asmr.2020.04.013 eCollection 2020 Aug.

30.

Castelein B, Cools A, Parlevliet T, Cagnie B. The influence of induced shoulder muscle pain on rotator cuff and scapulothoracic muscle activity during elevation of the arm. J Shoulder Elb Surg. 2017;26:497–505. https://doi.org/10.1016/j.jse.2016.09.005.CrossRef

31.

Chaconas EJ, Kolber MJ, Hanney WJ, Daugherty ML, Wilson SH, Sheets C. Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomised controlled trial. Int J Sports Phys Ther. 2017;12:1121–33. https://doi.org/10.26603/ijspt20171121.CrossRefPubMedPubMedCentral

32.

Cha JY, Kim JH, Hong J, Choi YT, Kim MH, Cho JH, et al. A 12-week rehabilitation program improves body composition, pain sensation, and internal/external torques of baseball pitchers with shoulder impingement symptom. J Exerc Rehabil. 2014;10:35–44. https://doi.org/10.12965/jer.140087.CrossRefPubMedPubMedCentral

33.

Bak K, Magnusson SP. Shoulder strength and range of motion in symptomatic and pain-free elite swimmers. Am J Sports Med. 1997;25:454–9. https://doi.org/10.1177/036354659702500407.CrossRefPubMed

34.

Jobe FW, Pink M. Classification and treatment of shoulder dysfunction in the overhead athlete. J Orthop Sports Phys Ther. 1993;18:427–32. https://doi.org/10.2519/jospt.1993.18.2.427.CrossRefPubMed

35.

Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med. 2008;36:1789–98. https://doi.org/10.1177/0363546508316281.CrossRefPubMed

36.

Bateman M, Adams N. A randomised controlled feasibility study investigating the use of eccentric and concentric strengthening exercises in the treatment of rotator cuff tendinopathy. SAGE Open Med. 2014;28(2):2050312113520151. https://doi.org/10.1177/2050312113520151.CrossRef

37.

Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005;35:227–38. https://doi.org/10.2519/jospt.2005.35.4.227.CrossRefPubMed

38.

Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elb Surg. 2006;15:324–30. https://doi.org/10.1016/j.jse.2005.08.011.CrossRef

39.

Rosa DP, Borstad JD, Pogetti LS, Camargo PR. Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain. J Hand Ther. 2017;30:20–9. https://doi.org/10.1016/j.jht.2016.06.006.CrossRefPubMed

40.

Roy JS, MacDermid JC, Woodhouse LJ. A systematic review of the psychometric properties of the constant-Murley score. J Shoulder Elb Surg. 2010;19:157–64. https://doi.org/10.1016/j.jse.2009.04.008.CrossRef

41.

L'Insalata JC, Warren RF, CohenSB ADW, Peterson MG. A self-administered questionnaire for assessment of symptoms and function of the shoulder. J Bone Joint Surg Am. 1997;79:738–48.CrossRef

42.

Chang A, Miller TT. Imaging of tendons. Sports. Health. 2009;1:293–300. https://doi.org/10.1177/1941738109338361.CrossRef

43.

Kanto K, Lähdeoja T, Paavola M, Aronen P, Järvinen TLN, Jokihaara J, et al. Minimal important difference and patient acceptable symptom state for pain, constant-Murley score and simple shoulder test in patients with subacromial pain syndrome. BMC Med Res Methodol. 2021;21:45. https://doi.org/10.1186/s12874-021-01241-w.CrossRefPubMedPubMedCentral

44.

Henseler JF, Kolk A, Van der Zwaal P, et al. The minimal detectable change of the constant score in impingement, full-thickness tears, and massive rotator cuff tears. J Shoulder Elb Surg. 2015;24:376–8.CrossRef

45.

Dabija D, Jain NB. Minimal clinically important difference of shoulder outcome measures and diagnoses: a systematic review. Am J Phys Med Rehabil. 2019;98:671–6. https://doi.org/10.1097/PHM.0000000000001169.CrossRefPubMedPubMedCentral

46.

Moser JS, Barker KL, Doll HA, Carr AJ. Comparison of two patient-based outcome measures for shoulder instability after nonoperative treatment. J Shoulder Elb Surg. 2008;17:886–92. https://doi.org/10.1016/j.jse.2008.05.040 Epub 2008 Sep 10.CrossRef

47.

Faber M, Andersen MH, Sevel C, Thorborg K, Bandholm T, Rathleff M. The majority are not performing home-exercises correctly two weeks after their initial instruction-an assessor-blinded study. Peer J. 2015;21(3):e1102. https://doi.org/10.7717/peerj.1102.CrossRef

48.

Murray M, Lange B, Nørnberg BR, Søgaard K, Sjøgaard G. Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial. BMC Musculoskelet Disord. 2017;7(18):147. https://doi.org/10.1186/s12891-017-1507-3.CrossRef

49.

Härkäpää K, Järvikoski A, Mellin G, Hurri H, Luoma J. Health locus of control beliefs and psychological distress as predictors for treatment outcome in low-back pain patients: results of a 3-month follow-up of a controlled intervention study. Pain. 1991;46:35–41. https://doi.org/10.1016/0304-3959(91)90031-r.CrossRefPubMed

50.

Nihal B, Ali K, Semih A, Nuray A. Comparison of the results of supervised physiotherapy program and home-based exercise program in patients treated with arthroscopic-assisted mini-open rotator cuff repair. Eklem Hastalik Cerrahisi. 2011;22:134–9.

51.

Holmgren T, Oberg B, Sjöberg I, Johansson K. Supervised strengthening exercises versus home-based movement exercises after arthroscopic acromioplasty: a randomized clinical trial. J Rehabil Med. 2012;44:12–8. https://doi.org/10.2340/16501977-0889.CrossRefPubMed

52.

Abdulla SY, Southerst D, Côté P, Shearer HM, Sutton D, Randhawa K, et al. 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;20:646–56. https://doi.org/10.1016/j.math.2015.03.013.CrossRefPubMed

53.

Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, et al. Three months of progressive high-load versus traditional low-load strength training among patients with rotator cuff tendinopathy: primary results from the double-blind randomized controlled RoCTEx trial. Orthop J Sports Med. 2017;28(5):2325967117723292. https://doi.org/10.1177/2325967117723292.CrossRef

54.

Maenhout AG, Mahieu NN, De Muynck M, De Wilde LF, Cools AM. 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;21:1158–67. https://doi.org/10.1007/s00167-012-2012-8.CrossRefPubMed

55.

Hegedus EJ, Cook C, Lewis J, Wright A, Park JY. Combining orthopedic special tests to improve diagnosis of shoulder pathology. Phys Ther Sport. 2015;16:87–92. https://doi.org/10.1016/j.ptsp.2014.08.001.CrossRefPubMed

56.

Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42:80–92; discussion 92. https://doi.org/10.1136/bjsm.2007.038406.CrossRefPubMed

57.

Vind M, Bogh SB, Larsen CM, Knudsen HK, Søgaard K, Juul-Kristensen B. Inter-examiner reproducibility of clinical tests and criteria used to identify subacromial impingement syndrome. BMJ Open. 2011;18(1):e000042. https://doi.org/10.1136/bmjopen-2010-000042.CrossRef

58.

Zheng F, Wang H, Gong H, Fan H, Zhang K, Du L. Role of ultrasound in the detection of rotator-cuff syndrome: an observational study. Med Sci Monit. 2019;6(25):5856–63. https://doi.org/10.12659/MSM.915547.CrossRef

59.

Lilje SC, Olander E, Berglund J, Skillgate E, Anderberg P. Experiences of older adults with Mobile phone text messaging as reminders of home exercises after specialized manual therapy for recurrent low Back pain: a qualitative study. JMIR Mhealth Uhealth. 2017;30(5):e39. https://doi.org/10.2196/mhealth.7184.CrossRef

60.

Andersen LL. Influence of psychosocial work environment on adherence to workplace exercise. J Occup Environ Med. 2011;53:182–4. https://doi.org/10.1097/JOM.0b013e3181207a01f.CrossRefPubMed

61.

Charbonnier C, Lädermann A, Kevelham B, Chagué S, Hoffmeyer P, Holzer N. Shoulder strengthening exercises adapted to specific shoulder pathologies can be selected using new simulation techniques: a pilot study. Int J Comput Assist Radiol Surg. 2018;13:321–30. https://doi.org/10.1007/s11548-017-1668-4.CrossRefPubMed

Title: Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial
Authors: Pierre Schydlowsky
Marcin Szkudlarek
Ole Rintek Madsen
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Subacromiales Impingement
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04969-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fractures

Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?—An ambispective study

Correlation between CT images of lateral plateau and lateral meniscus injuries in patients with Schatzker II tibial plateau fractures:a retrospective study

Efficiency of a novel vertebral body augmentation system (Tektona™) in non-osteoporotic spinal fractures

Clinical outcomes of patients with pigmented villonodular synovitis of the shoulder after arthroscopic synovectomy

Ligamentous injury-induced ankle instability causing posttraumatic osteoarthritis in a mouse model