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Publication date and title: Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial.

 Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial.

Key learning points:

  1. This article aims to compare the effectiveness of three different kinds of progressive loading exercise programmes in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome.
  2. Shoulder pain affects 16-21% of the general population and one of the most common causes of shoulder pain is rotator cuff (RC) tendinopathy/shoulder impingement syndrome (SIS).
  3. Functional impairment from RC tendinopathy pain is estimated to cost the United Kingdom £310m per annum.
  4. It has been concluded from previous studies that exercise improves the results in treating RC tendinopathy/SIS – progressive loading of the RC structures was suggested to be an important factor in these studies.
  5. Authors have however used different loading methods; and this study aims to compare three different progressive loading programmes in treating RC tendinopathy/SIS.
  6. The following three programmes were compared in the randomised controlled trial: Open chain resisted exercise (OC), Closed chain exercises (CC), Range of movement exercises (ROM).
  7. SPADI (Shoulder Pain and Disability Index) score was primarily used to measure outcomes because of its good test-re-test reliability and sensitivity to change.
  8. An exercise diary was also maintained by patients to log exercise performance.
  9. Follow-up was done following 6 weeks of starting treatment and SPADI was re-assessed.
  10. All three groups demonstrated significant statistical reductions in SPADI scores at the six week follow-up; however, it was not concluded that any of the approaches gave superior outcomes in the primary analysis. This could suggest that what is important is that the RC is dynamically loaded, rather than how it is loaded.

Application to practice:

  1. Repeated activation of the RC can result in reduced nociceptive stimuli and peripheral and/or central neurological sensitivity.
  2. Reassurance from the treating physiotherapist and gradual exposure to the use of the shoulder may reduce yellow flags related to pain and disability.
  3. It might be beneficial to incorporate more than one of the above strategies while planning an exercise programme to avoid non-compliance to any one form of exercise and to engage them to the treatment.
  4. Progressive loading through the exercise intensity may be more effective in increasing the positive response to exercise.
  5. Patient’s exercise preference can be sought and built up on when prescribing exercises

Action plan:

  1. This study had a high dropout rate amongst participants, especially in the CC group. Future studies might need to employ alternative methods of post-treatment data collection.
  2. Data was collected for only 6 weeks post treatment. Long term efficacy of treatments is not clear from this study.
  3. A mix of open and closed chain exercises, based on patient’s preferences and responses to exercises will make the treatment most effective.

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