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Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate superior value of adding heavy load eccentric training to conservative treatment in patients with subacromial impingement.

Methods

Sixty-one patients with subacromial impingement were included and randomly allocated to the traditional rotator cuff training (TT) group (n = 30, mean age = 39.4 ± 13.1 years) or traditional rotator training combined with heavy load eccentric training (TT + ET) group (n = 31, mean age = 40.2 ± 12.9 years). Isometric strength was measured to abduction at 0°, 45° and 90° of scapular abduction and to internal and external rotation. The SPADI questionnaire was used to measure shoulder pain and function. Patients rated subjective perception of improvement. Outcome was assessed at baseline, at 6 and 12 weeks after start of the intervention. Both groups received 9 physiotherapy treatments over 12 weeks. At home, the TT group performed traditional rotator cuff strengthening exercises 1x/day. The TT + ET group performed the same exercises 1x/day and a heavy load eccentric exercise 2x/day.

Results

After treatment, isometric strength had significantly increased in all directions, and SPADI score had significantly decreased. The TT + ET group showed a 15 % higher gain in abduction strength at 90° of scapular abduction. Chi-square tests showed patients’ self-rated perception of improvement was similar in both groups.

Conclusion

Adding heavy load eccentric training resulted in a higher gain in isometric strength at 90° of scapular abduction, but was not superior for decreasing pain and improving shoulder function. This study showed that the combination of a limited amount of physiotherapy sessions combined with a daily home exercise programme is highly effective in patients with impingement.

Level of evidence

II.

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Acknowledgments

The authors are deeply grateful to the volunteers that participated in this study.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Annelies G. Maenhout.

Additional information

The protocol of this study was approved by the Institutional Review Board of Ghent University Hospital (Registration number: B67020084347) and is registered on ClinicalTrials.gov (NTC00782522).

Appendix

Appendix

See Figs. 2 and 3; Table 6.

Fig. 2
figure 2

Resisted internal a and external rotation b with rubber band

Fig. 3
figure 3

Eccentric full can abduction exercise

Table 6 Additional individualized physiotherapy treatment

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Maenhout, A.G., Mahieu, N.N., De Muynck, M. et al. Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial. Knee Surg Sports Traumatol Arthrosc 21, 1158–1167 (2013). https://doi.org/10.1007/s00167-012-2012-8

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