Advertisement

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

  • Annelies G. Maenhout
  • Nele N. Mahieu
  • Martine De Muynck
  • Lieven F. De Wilde
  • Ann M. Cools
shoulder

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.

Keywords

Shoulder impingement syndrome Physiotherapy Eccentric training Tendon 

Notes

Acknowledgments

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

References

  1. 1.
    Alfredson H, Pietila T, Jonsson P, Lorentzon R (1998) Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 26:360–366PubMedGoogle Scholar
  2. 2.
    Allison GT, Purdam C (2009) Eccentric loading for achilles tendinopathy—strengthening or stretching? Br J Sports Med 43:276–279PubMedCrossRefGoogle Scholar
  3. 3.
    Bennell K, Coburn S, Wee E, Green S, Harris A, Forbes A, Buchbinder R (2007) Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: a protocol for a randomised, double-blind, placebo-controlled trial. BMC Musculoskelet Disord 8:86PubMedCrossRefGoogle Scholar
  4. 4.
    Bernhardsson S, Klintberg IH, Wendt GK (2011) Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome. Clin Rehabil 25:69–78PubMedCrossRefGoogle Scholar
  5. 5.
    Bohannon RW (1997) Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil 78:26–32PubMedCrossRefGoogle Scholar
  6. 6.
    Bot SD, van der Waal JM, Terwee CB, Van der Windt DA, Schellevis FG, Bouter LM, Dekker J (2005) Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis 64:118–123PubMedCrossRefGoogle Scholar
  7. 7.
    Camargo PR, Avila MA, Alburquerque-Sendin F, Asso NA, Hashimoto LH, Salvini TF (2012) Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series. Rev Bras Fisioter 16:74–83PubMedCrossRefGoogle Scholar
  8. 8.
    Cools AM, Cambier D, Witvrouw EE (2008) Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br J Sports Med 42:628–635PubMedCrossRefGoogle Scholar
  9. 9.
    Engebretsen K, Grotle M, Bautz-Holter E, Sandvik L, Juel NG, Ekeberg OM, Brox JI (2009) Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. BMJ 339:3360CrossRefGoogle Scholar
  10. 10.
    Hawkins RJ, Kennedy JC (1980) Impingement syndrome in athletes. Am J Sports Med 8:151–158PubMedCrossRefGoogle Scholar
  11. 11.
    Hurschler C, Wulker N, Mendila M (2000) The effect of negative intraarticular pressure and rotator cuff force on glenohumeral translation during simulated active elevation. Clin Biomech (Bristol Avon) 15:306–314CrossRefGoogle Scholar
  12. 12.
    Itoi E, Kido T, Sano A, Urayama M, Sato K (1999) Which is more useful, the “full can test” or the “empty can test,” in detecting the torn supraspinatus tendon? Am J Sports Med 27:65–68PubMedGoogle Scholar
  13. 13.
    Jobe FW, Moynes DR (1982) Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med 10:336–339PubMedCrossRefGoogle Scholar
  14. 14.
    Jonsson P, Wahlstrom P, Ohberg L, Alfredson H (2006) Eccentric training in chronic painful impingement syndrome of the shoulder: results of a pilot study. Knee Surg Sports Traumatol Arthrosc 14:76–81PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly BT, Kadrmas WR, Speer KP (1996) The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med 24:581–588PubMedCrossRefGoogle Scholar
  16. 16.
    Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M (1999) Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 27:393–408PubMedCrossRefGoogle Scholar
  17. 17.
    Kuhn JE (2009) Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Should Elbow Surg 18:138–160CrossRefGoogle Scholar
  18. 18.
    Langberg H, Ellingsgaard H, Madsen T, Jansson J, Magnusson SP, Aagaard P, Kjaer M (2007) Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports 17:61–66PubMedGoogle Scholar
  19. 19.
    Lewis JS (2009) Rotator cuff tendinopathy. Br J Sports Med 43:236–241PubMedCrossRefGoogle Scholar
  20. 20.
    Lombardi I Jr, Magri AG, Fleury AM, Da Silva AC, Natour J (2008) Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthr Rheum 59:615–622CrossRefGoogle Scholar
  21. 21.
    Ludewig PM, Borstad JD (2003) Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med 60:841–849PubMedCrossRefGoogle Scholar
  22. 22.
    MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S (2004) The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Should Elbow Surg 13:593–598CrossRefGoogle Scholar
  23. 23.
    MacDermid JC, Solomon P, Prkachin K (2006) The shoulder pain and disability index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord 7:12PubMedCrossRefGoogle Scholar
  24. 24.
    Mahieu NN, McNair P, Cools A, D’Haen C, Vandermeulen K, Witvrouw E (2008) Effect of eccentric training on the plantar flexor muscle-tendon tissue properties. Med Sci Sports Exerc 40:117–123PubMedGoogle Scholar
  25. 25.
    Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Jt Surg Am 54:41–50Google Scholar
  26. 26.
    Neer CS (2005) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972. J Bone Jt Surg Am 87:1399CrossRefGoogle Scholar
  27. 27.
    Ohberg L, Alfredson H (2004) Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc 12:465–470PubMedCrossRefGoogle Scholar
  28. 28.
    Ohberg L, Lorentzon R, Alfredson H (2004) Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med 38:8–11PubMedCrossRefGoogle Scholar
  29. 29.
    Reinold MM, Escamilla RF, Wilk KE (2009) Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther 39:105–117PubMedGoogle Scholar
  30. 30.
    Reinold MM, Macrina LC, Wilk KE, Fleisig GS, Dun S, Barrentine SW, Ellerbusch MT, Andrews JR (2007) Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. J Athl Train 42:464–469PubMedGoogle Scholar
  31. 31.
    Royer PJ, Kane EJ, Parks KE, Morrow JC, Moravec RR, Christie DS, Teyhen DS (2009) Fluoroscopic assessment of rotator cuff fatigue on glenohumeral arthrokinematics in shoulder impingement syndrome. J Should Elbow Surg 18:968–975CrossRefGoogle Scholar
  32. 32.
    Seitz AL, McClure PW, Finucane S, Boardman DN III, Michener LA (2011) Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomechan 26:1–12CrossRefGoogle Scholar
  33. 33.
    Sharkey NA, Marder RA (1995) The rotator cuff opposes superior translation of the humeral head. Am J Sports Med 23:270–275PubMedCrossRefGoogle Scholar
  34. 34.
    Silbernagel KG, Thomee R, Thomee P, Karlsson J (2001) Eccentric overload training for patients with chronic Achilles tendon pain–a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports 11:197–206PubMedCrossRefGoogle Scholar
  35. 35.
    Thomee R (1997) A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther 77:1690–1703PubMedGoogle Scholar
  36. 36.
    Tyler TF, Nahow RC, Nicholas SJ, McHugh MP (2005) Quantifying shoulder rotation weakness in patients with shoulder impingement. J Should Elbow Surg 14:570–574CrossRefGoogle Scholar
  37. 37.
    Van der Windt DA, Koes BW, de Jong BA, Bouter LM (1995) Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 54:959–964PubMedCrossRefGoogle Scholar
  38. 38.
    Williams JW Jr, Holleman DR Jr, Simel DL (1995) Measuring shoulder function with the shoulder pain and disability index. J Rheumatol 22:727–732PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Annelies G. Maenhout
    • 1
  • Nele N. Mahieu
    • 1
  • Martine De Muynck
    • 2
  • Lieven F. De Wilde
    • 2
  • Ann M. Cools
    • 1
  1. 1.Department of Physiotherapy and Rehabilitation SciencesGhent UniversityGhentBelgium
  2. 2.Department of Orthopaedic Surgery, Physical Medicine and RehabilitationGhent University HospitalGhentBelgium

Personalised recommendations