Exercise into Pain in Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial with 6-Month Follow-Up

Abstract

Claudia Cavaggion,1 Alejandro Luque-Suarez,2,3 Lennard Voogt,4,5 Birgit Juul-Kristensen,6 Guy Wollants,7 Lucas Beke,7 Erik Fransen,8 Filip Struyf1 1Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; 2Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain; 3Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain; 4Rotterdam University of Applied Sciences, Department of Physical Therapy Studies and Research Centre for Health Care Innovations, Rotterdam, the Netherlands; 5Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 6Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; 7Groepspraktijk Beke & Wollants, Hove, Belgium; 8Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, BelgiumCorrespondence: Alejandro Luque-Suarez, Faculty of Health Sciences, Universidad de Malaga, Arquitecto Penalosa s/n, Malaga, 29002, Spain, Email [email protected]: Exercise therapy is the first-line treatment in rotator cuff-related shoulder pain (RCRSP), and diverse types of exercise seem effective. However, it is not still clear if painful exercise should be allowed or avoided during exercises. The objective of this study was to investigate if exercise into pain is more effective than no pain in RCRSP.Patients and Methods: A randomized controlled trial was conducted in a physiotherapy clinic in Belgium. Forty-three participants with chronic RCRSP were randomly allocated to G1 (exercising into pain) or G2 (exercising without pain) in a 12-week intervention with 6-month follow-up. Primary outcome was the Shoulder Pain and Disability Index (SPADI); secondary outcomes were pain intensity, fear-avoidance beliefs, fear of pain, quality of life, strength, and range of motion. Outcomes were measured at baseline (T0), after 9 weeks (T1), 12 weeks (T2), and 6 months (T3) from the first session and analysed with linear mixed models.Results: No between-group difference in SPADI (time-by-group interaction, p = 0.25) up to 6 months was found, with mean difference (G1-G2) at T1 = 5.78 (CI95%: − 3.43,14.59; p = 0.33), at T2 = 0.93 (CI95%: − 7.20,9.05; p = 0.82), at T3 = 4.15 (CI95%: − 2.61,10.92; p = 0.33). No between-group differences were found for any other outcomes.Conclusion: Pain provocation seems not to be necessary in RCRSP for achieving successful treatment effect in pain and disability reduction, fear-related beliefs, and quality of life up to 6 months.Trial Registration: ClinicalTrials.gov NCT04553289.Keywords: shoulder pain, rehabilitation, physical therapy modalities, shoulder impingement syndrome, exercise therapy

Keywords

• shoulder pain
• rehabilitation
• physical therapy modalities
• shoulder impingement syndrome
• exercise therapy