Exercise Into Pain in Subacromial Shoulder Pain
- Conditions
- Shoulder Impingement Syndrome
- Interventions
- Other: exercising with no/slight painOther: exercising into pain
- Registration Number
- NCT04553289
- Lead Sponsor
- Universiteit Antwerpen
- Brief Summary
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.
- Detailed 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 43
- 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)
- 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
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description exercising with no/slight pain exercising with no/slight pain 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. exercising into pain exercising into pain 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.
- Primary Outcome Measures
Name Time Method Shoulder Pain and Disability Index (SPADI) Change from baseline to 12 weeks There are 13 items, divided in two subscales: pain (5 items) and function (8 items). Each item is scored from 0 (no pain/no difficulty) to 10 (worst imaginable pain/so difficult it requires help) on a NPRS. The final score is a percentage derived from an average of the two subscales, where higher score means worse outcome.
- Secondary Outcome Measures
Name Time Method Maximum Voluntary Contraction (MVC) in internal rotation, external rotation, scaption Change from baseline to 6 months It is measured with the Hand-Held Dynamometer. The unit of measure is Newtons.
Scapular Correction Change from baseline to 6 months it is measured with the reduction of symptoms during 2 tests: 2) the scapular assistance test (SAT); if the pain reduces after the SAT, the test is considered positive; 3) scapular retraction test (SRT); if the pain reduces after the SRT, the test is considered positive.
Supraspinatus Tendon Thickness Change from baseline to 6 months it is measured with the Ultrasound in Crass position (in millimeters)
Visual Analogue Scale (VAS) Change from baseline to 6 months It measures pain at rest, during activity, during night, in the past 24 hours. It is measured on a scale from 0 to 100, where 0=no pain, 100=worst imaginable pain.
Health-Related Quality of Life Change from baseline to 6 months It is measured with: 1) EQ-5D-5L (EuroQol-5 dimentions-5 levels) index: score range from less than 0 (0=value of health state equivalent to dead; negative values indicate state worse than dead) to 1 (the value of full health), with higher scores indicating higher health; 2) EQ-5D VAS (EuroQol-5 dimentions-Visual Analogue Scale), from 0 to 100 score, with 0=lowest health-related quality of life, 100=best health-related quality of life)
Fear-Avoidance Beliefs Questionnaire (FABQ) Change from baseline to 6 months It consists of 16 items and it has 2 subscales: Physical Activity (FABQ-PA, range: 0-24) and Work (FABQ-W, range: 0-42) higher scores mean more fear avoidance beliefs affecting physical activity and/or work.
Scapular Dyskinesis Change from baseline to 6 months It is measured with visual observation at rest and during movement (loaded and unloaded, in abduction and in flexion); the presence of winging, tilting or abnormal scapular movement determines the judgement about scapular dyskinesis (yes/no) at rest and during movement
Acromiohumeral Distance Change from baseline to 6 months it is measured with the Ultrasound at 0 and 60 degrees of elevation in the scapular plane (in millimeters)
Fear of Pain Questionnaire (FPQ-9) Change from baseline to 6 months It is a shortened version of the Fear of Pain Questionnaire-III. The total score ranges between 9 and 45; higher scores mean more fear and anxiety associated with pain.
Range of Movement (ROM) in internal rotation, external rotation, scaption Change from baseline to 6 months It is measured with the inclinometer. The unit of measure is degrees.
Coracohumeral distance Change from baseline to 6 months it is measured with the Ultrasound at 0 and 60 degrees of elevation in the scapular plane (in millimeters)
Subscapularis Tendon Thickness Change from baseline to 6 months it is measured with the Ultrasound in maximal external rotation (in millimeters)
Shoulder Pain and Disability Index (SPADI) Change from baseline to 6 months There are 13 items, divided in two subscales: pain (5 items) and function (8 items). Each item is scored from 0 (no pain/no difficulty) to 10 (worst imaginable pain/so difficult it requires help) on a NPRS. The final score is a percentage derived from an average of the two subscales, where higher score means worse outcome.
Trial Locations
- Locations (1)
Physiotherapy private practices
🇧🇪Antwerp, Belgium