Level of pain catastrophising determines if patients with long-standing subacromial impingement benefit from more resistance exercise: Predefined secondary analyses from a pragmatic randomised controlled trial (the SExSI Trial)

Review written by Ben Cormack info

Key Points

  1. Lower pain catastrophizing level at baseline benefit more from added resistance training.
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Shoulder pain is common, with 1 in 6 adults experiencing shoulder pain for over a week each month (1). The most common type of shoulder pain is ‘sub acromial impingement’ that accounts for around 2/3rds of shoulder pain. Exercise is a first line treatment option for non-operative cases and previous research has failed to show an optimal type or dose of exercise. The SExSI Trial (Strengthening Exercises in Shoulder Impingement Trial), found that adding a large dose of shoulder strengthening exercises did not result in superior outcomes above current non operative care.

This paper, a secondary analysis of the SexSI trial, aimed to:

  1. To investigate the effectiveness of adding more resistance exercise to usual care on pain mechanisms, temporal summation, conditioned pain modulation (CPM) and local pain sensitivity, and pain catastrophizing.

  2. To investigate the modifying effect of pain mechanisms and pain catastrophizing on the interventions’ effectiveness in improving shoulder strength and disability.

1 in 6 adults experience shoulder pain for over a week each month.
Exercises for pain and disability may not be mediated by traditional exercises parameters such as strength, range of motion or motor control.


Both groups received usual non-operative care with the intervention group receiving additional high volume resistance training. The intervention group received 3 blocks of exercises, with additional exercises and exercise load being progressively added (see video below for additional exercises).

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