Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 7, pp 2051–2059 | Cite as

Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized, single blinded, clinical trial

  • Beate DejacoEmail author
  • Bas Habets
  • Corné van Loon
  • Susan van Grinsven
  • Robert van Cingel



To investigate the effectiveness of isolated eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy.


Thirty-six patients with rotator cuff tendinopathy, diagnosed by an orthopaedic surgeon, were included and randomly allocated to an isolated eccentric exercise (EE) group (n = 20, mean age = 50.2 ± 10.8 years) or a conventional exercise (CG) group (n = 16, mean age = 48.6 ± 12.3 years). Both groups fulfilled a 12-week daily home-based exercise programme and received a total amount of nine treatment sessions. The Constant Murley score was used to evaluate both objective (e.g. range of motion and strength) and subjective measures (e.g. pain and activities of daily living). A visual analogue scale (VAS) was used to evaluate pain during daily activities. As secondary outcomes, shoulder range of motion and isometric abduction strength in 45° in the scapular plane were evaluated. All measurements were taken at baseline, at 6, 12 and 26 weeks.


After 26 weeks, both groups showed a significant increase in the Constant Murley score and a significant decrease in VAS scores. No difference was found between the groups, for any of the evaluated outcome measures.


A 12-week-isolated eccentric training programme of the rotator cuff is beneficial for shoulder function and pain after 26 weeks in patients with rotator cuff tendinopathy. However, it is no more beneficial than a conventional exercise programme for the rotator cuff and scapular muscles. Based on the results, clinicians should take into account that performing two eccentric exercises twice a day is as effective as performing six concentric/eccentric exercises once a day in patients with rotator cuff tendinopathy.


Rotator cuff tendinopathy, subacromial pain syndrome Exercise therapy Resistance training Eccentric training 



The authors would like to thank Peer Konings and Nicky van Melick for their assistance in the development of the study protocol and recruitment of study participants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Alfredson H, Lorentzon R (2003) Intratendinous glutamate levels and eccentric training in chronic Achilles tendinosis: a prospective study using microdialysis technique. Knee Surg Sports Traumatol Arthrosc 11:196–199CrossRefPubMedGoogle Scholar
  2. 2.
    Bigliani LU, Cofield RH, Flatow EL, Fukuda HA, Hawkins RJ, Matsen FA 3rd, Morrison DS Jr, Rockwood CA, Warren RF (2009) Charles Neer: on the giant of the shoulder. J Shoulder Elbow Surg 18:333–338CrossRefPubMedGoogle Scholar
  3. 3.
    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 78:26–32CrossRefPubMedGoogle Scholar
  4. 4.
    Bohm S, Mersmann F, Arampatzis A (2015) Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open 1(1):1CrossRefGoogle Scholar
  5. 5.
    Braman JP, Zhao KD, Lawrence RL, Harrison AK, Ludewig PM (2014) Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy. Med Biol Eng Comput 52:211–219CrossRefPubMedGoogle Scholar
  6. 6.
    Bron C, Wensing M, Franssen JL, Oostendorp RA (2007) Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066. BMC Musculoskelet Disord 5:107CrossRefGoogle Scholar
  7. 7.
    Bullock MP, Foster NE, Wright CC (2005) Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Man Ther 10:28–37CrossRefPubMedGoogle Scholar
  8. 8.
    Conable KM, Rosner AL (2011) A narrative review of manual muscle testing and implications for muscle testing research. J Chiropr Med 10:157–165PubMedPubMedCentralGoogle Scholar
  9. 9.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  10. 10.
    Cools AM, Johansson FR, Cagnie B, Cambier DC, Witvrouw EE (2012) Stretching the posterior shoulder in subjects with internal rotation deficit: comparison of two stretching techniques. Shoulder Elbow 4:56–63CrossRefGoogle Scholar
  11. 11.
    Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, Willems J, Winters J, van der Woude HJ, Association Dutch Orthopaedic (2014) Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop 85:314–322CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ellenbecker TS, Cools A (2010) Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med 44:319–327CrossRefPubMedGoogle Scholar
  13. 13.
    Graichen H, Hinterwimmer S, von Eisenhart-Rothe R, Vogl T, Englmeier KH, Eckstein F (2005) Effect of abducting and adducting muscle activity on glenohumeral translation, scapular kinematics and subacromial space width in vivo. J Biomech 38:755–760CrossRefPubMedGoogle Scholar
  14. 14.
    Greving K, Dorrestijn O, Winters JC, Groenhof F, van der Meer K, Stevens M, Diercks RL (2012) Incidence, prevalence, and consultation rates of shoulder complaints in general practice. Scand J Rheumatol 41:150–155CrossRefPubMedGoogle Scholar
  15. 15.
    Habets B, Van Cingel REH (2015) Eccentric exercise training in chronic mid-portion Achilles tendinopathy: a systematic review on different protocols. Scand J Med Sci Sports 25:3–15CrossRefPubMedGoogle Scholar
  16. 16.
    Holmgren T, Bjornsson Hallgren H, Oberg B, Adolfsson L, Johansson K (2012) Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ 344:e787CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    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 14:76–81CrossRefPubMedGoogle Scholar
  18. 18.
    Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD (2013) Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med 47:877–885CrossRefPubMedGoogle Scholar
  19. 19.
    Lewis J, McCreesh K, Roy JS, Ginn K (2015) Rotator Cuff Tendinopathy: navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther 43:236–241Google Scholar
  20. 20.
    Ludewig PM, Reynolds JF (2009) The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 39:90–104CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Maenhout AG, Mahieu NN, De Muynck M, De Wilde LF, Cools AM (2013) 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 21:1158–1167CrossRefPubMedGoogle Scholar
  22. 22.
    Malliaras P, Barton C, Reeves N, Langberg H (2013) Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med 43:267–286CrossRefPubMedGoogle Scholar
  23. 23.
    Ogawa K, Yoshida A, Inokuchi W, Naniwa T (2005) Acromial spur: relationship to aging and morphologic changes in the rotator cuff. J Shoulder Elbow Surg 14:591–598CrossRefPubMedGoogle Scholar
  24. 24.
    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 38:8–11CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    O’Neill S, Watson PJ, Barry S (2015) Why are eccentric exercises effective for achilles tendinopathy? Int J Sports Phys Ther 10:552–562PubMedPubMedCentralGoogle Scholar
  26. 26.
    Riley GP, Harrall RL, Constant CR, Chard MD, Cawston TE, Hazleman BL (1994) Tendon degeneration and chronic shoulder pain: changes in the collagen composition of the human rotator cuff tendons in rotator cuff tendinitis. Ann Rheum Dis 53:359–366CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Rocourt MH, Radlinger L, Kalberer F, Sanavi S, Schmid NS, Leunig M, Hertel R (2008) Evaluation of intratester and intertester reliability of the Constant-Murley shoulder assessment. J Shoulder Elbow Surg 17:364–369CrossRefPubMedGoogle Scholar
  28. 28.
    Roy JS, MacDermid JC, Woodhouse LJ (2010) A systematic review of the psychometric properties of the Constant-Murley score. J Shoulder Elbow Surg 19:157–164CrossRefPubMedGoogle Scholar
  29. 29.
    Rutten MJ, Jager GJ, Kiemeney LA (2010) Ultrasound detection of rotator cuff tears: observer agreement related to increasing experience. AJR Am J Roentgenol 195:W440–W446CrossRefPubMedGoogle Scholar
  30. 30.
    Seitz AL, McClure PW, Finucane S, Boardman ND 3rd, Michener LA (2011) Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech (Bristol, Avon) 26:1–12CrossRefGoogle Scholar
  31. 31.
    Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  1. 1.Sports Medical Center PapendalArnhemThe Netherlands
  2. 2.HAN University of Applied Sciences Research Group Musculoskeletal RehabilitationNijmegenThe Netherlands
  3. 3.Department of Orthopaedic SurgeryRijnstate HospitalArnhemThe Netherlands

Personalised recommendations