Exercise Into Pain in Subacromial Shoulder Pain

Universiteit Antwerpen

Status: Completed

Conditions: Shoulder Impingement Syndrome

Treatments: Other: exercising into pain; Other: exercising with no/slight pain

Study type: Interventional

Funder types: Other

Identifiers

NCT04553289

18/34/379 (RCT)

Details and patient eligibility

About

The aim of the randomized clinical trial is to investigate if "exercising into pain" gives better results in term of clinical outcomes compared to a non-painful exercise program.

Full description

Exercise therapy is the first choice of treatment in the treatment of subacromial shoulder pain (SSP). Guidelines suggest exercise therapy for at least three months and research underlines the importance of progressive loaded exercise therapy at high dosage. However, it is not clear which is the best type of exercise and if pain should be provoked or avoided during exercise. Recent research found that painful exercises are beneficial in short term on pain and function in patients with different kinds of chronic musculoskeletal pain. The aim is to investigate if one painful exercise can give better and faster results in the management of SSP than non-painful program.

Enrollment: 43 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• shoulder pain for at least 3 months, elicited in the anterolateral shoulder region
• at least 3 out of 5 of the following tests positive: Neer test, Hawkins-Kennedy, Jobe, painful arc, external resistance test
• resting pain should be at 2/10 maximum on verbal numerical pain rating scale (NPRS)

Exclusion criteria

• bilateral shoulder pain
• corticosteroid injections 6 weeks prior to the study
• pregnancy, inability to understand spoken or written Dutch
• clinical signs of full-thickness rotator cuff tears (positive external and internal rotation lag tests and drop arm test)
• evidence of adhesive capsulitis
• previous cervical, thoracic or shoulder surgery; recent fractures or dislocations on the painful shoulder
• primary complaint of spinal pain or signs of central nervous system involvement or signs of cervical nerve root involvement; reproduction of shoulder pain with cervical rotation or axial compression
• primary diagnosis of acromioclavicular pathology, shoulder instability
• a radiologically confirmed fracture or previous medical imaging confirming the presence of calcification larger than 5 mm
• presence of competing pathologies (inflammatory arthritis, neurological disorders, fibromyalgia, malignancy, psychiatric illness, osteoporosis, hemophilia, rheumatic polymyalgia)
• more than 4h of training in sport overhead shoulder activities per week

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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43 participants in 2 patient groups

exercising into pain

Experimental group

Description:

The participants will train during 12 with progressive loaded exercises, three times per week. There are 9 sessions of supervised physiotherapy treatment, lasting 30 minutes, while the rest of the sessions is conducted as home exercises. There are 4 strengthening exercises, including 2 in closed kinetic chain exercises and 2 executed with the elastic band or with dumbbell/weight. One exercise will be performed with pain ranging between 4 and 7 on a NPRS (Numeric Pain Rating Scale) and the rest of the exercises will be performed with no/slight pain, ranging between 0 and 2 on NPRS. At week 9, patients will continue to exercise with pain between 0 and 2 in all exercises. 10/15 minutes of manual therapy (posterior capsular release) will be applied during the physiotherapy session.

Treatment:

Other: exercising into pain

exercising with no/slight pain

Active Comparator group

Description:

The participants will train during 12 weeks with progressive loaded exercises, three times per week. There are 9 sessions of supervised physiotherapy treatment, lasting 30 minutes, while the rest of the sessions is conducted as home exercises. There are 4 strengthening exercises, including 2 in closed kinetic chain exercises and 2 executed with the elastic band or with dumbbell/weight. All the exercises will be performed with no/slight pain, ranging between 0 and 2 on NPRS. 10/15 minutes of manual therapy (posterior capsular release) will be applied during the physiotherapy session.

Treatment:

Other: exercising with no/slight pain