Yi Jin Bang Exercise Versus Usual Exercise Therapy for the Treatment of Subacromial Pain Syndrome: a Pilot Randomized Controlled Trial

BACKGROUND

Shoulder pain is one of the most frequent musculoskeletal pain, with the point prevalence has been reported between 7% and 26%. The cumulative incidence of shoulder pain in general medical practice is estimated to be 29.3 per 1000 patients-years. Shoulder pain can cause severe disability and loss of quality of life because it interferes with many activities of daily life. There is little information about the costs associated with healthcare use and lost productivity in patients with shoulder pain, but it is considered considerable. Among the common causes of shoulder pain, SAPS is the most common cause, accounting for 44-60% of all shoulder pains. SAPS is characterized by pain and functional restrictions that are exacerbated with repetitive arm activities at or above shoulder level.

The main goals of treatment for patients with SAPS are to reduce pain-related common impairments and improve upper limb function. It has been determined that 15-28% of patients with SAPS may eventually require surgery. Commonly prescribed conservative treatment for SAPS includes corticosteroid injections, non-steroidal anti-inflammatory drugs, stretching and strengthening exercises, and physical therapy modalities. No evidence is available to indicate that the effectiveness of surgery is better than conservative treatment for patients with SAPS. A systematic review suggested that exercise therapy aimed at restoring flexibility and strength of scapular muscles and the rotator cuff should be recommended to the first-line treatment for patients with SAPS before undergoing surgical treatment. Besides, this systematic review indicated that low-level laser therapy, pulsed electromagnetic field and tape are ineffective in treating SAPS. In another meta-analytical study which investigated the effectiveness of conservative treatment for pain, function, and range of motion (ROM) in adults with SAPS, there revealed that exercise therapy should be considered for all adults with SAPS, and the addition of manual therapy, tape, laser and extracorporeal shockwave therapy might have a little benefit. In addition, the meta-analysis reported that nonsteroidal anti-inflammatory drugs or corticosteroid injection can be a useful alternative only when exercise therapy is not possible.

Exercise therapy is considered to be the most valuable method for treating shoulder disorders and is the cornerstone of physical therapy treatment, with several systematic reviews have reported its clinically and statistically effects on pain and function in patients with SAPS. It remains unknown whether exercise therapy should be performed with or without supervision. Several systematic reviews indicated that supervised exercises are effective in improving pain and function in patients with SAPS, while several other systematic reviews concluded that home-based unsupervised exercises are as effective as supervised exercises. However, supervised training requires substantial and specific resources and may be difficult to apply clinically. In addition, the increasing cost of supervised exercise therapy also supports the use of home-based self-training protocols.

The use of complementary and alternative medicine treatment is growing continuously. Yi Jin Bang exercise is a stretching exercise that is beneficial to the mind and body. It was created in the 1950s in Hong Kong, according to the principle of traditional Chinese mind-body exercise Yi Jin Jing. In Chinese, Yi means change, Jin means tendons and sinews, while Bang means stick. Although there is no scientific research evaluating the effects of Yi Jin Bang exercise on pain, there are many scientific studies that have examined the effects of other mind-body exercises (e.g., Qigong, Tai Chi, yoga) on pain. A study found that six months of supervised Qigong training was more effective than no treatment on pain in patients with chronic shoulder pain, and improvements in the Qigong group were comparable with those in the supervised exercise therapy group. Besides, another study indicated that six weeks of video-based Qigong training can improve neck-shoulder pain compared with no treatment. In a recent meta-analysis, Tai Chi was found effective in the short time for reducing pain and disability in patients with arthritis. A meta-analysis evaluated the effectiveness of yoga on low back pain, which found strong and moderate evidence for short-term effects and long-term effects of yoga in the treatment of low back pain, respectively. Moreover, a randomized controlled trial found that nine weeks of supervised yoga training was effective in treating chronic neck pain. Up to date, no studies have evaluated the effectiveness of Yi Jin Bang on the treatment of SAPS. Therefore, the purpose of this study is to evaluate the effects of Yi Jin Bang exercise on adults with SAPS in terms of pain, disability, flexibility, and muscular endurance.