BACKGROUND & OBJECTIVE
Shoulder pain is a common complaint managed by physiotherapists. This paper set out to compare two different exercise protocols for rehabilitation from rotator cuff tendinopathy (RCT), a Progressive High Load Exercise (PHLE) protocol with a more traditional low load (LLE) protocol. The reason for this comparison was the previous positive data from this type of training on tendinopathy in the knee and ankle that showed clinically relevant changes in pain and structural measures. The authors hypothesised that the PHLE would have statistically and clinically significant improvements in the outcome measures of DASH (Disability of the Arm Shoulder & Hand) questionnaire, and also pain and range of movement at the end of the 12 week study period.
The authors defined RCT as weakness, especially with elevation and external rotation, largely preserved range of motion and minimal resting pain. They authors also used ultrasound based signifiers of tendinopathy to aid diagnosis. The exercise protocol consisted of two exercises for scapulae stabilising muscles, two mobility exercises for the rotator cuff and scapulothoracic complex and two strengthening exercises for the rotator cuff muscles. The exercises were chosen based on previous research that had shown increased rotator cuff muscle activation in comparison to the deltoid muscle. The only difference between the two groups was the progression of load for the two strengthening exercises for the rotator cuff from a starting 15 rep max down to a 6 rep max at the 9-12 week stage.
The authors found no statistical difference between groups for any of the outcome measures, meaning that they had to reject their primary hypothesis that the PHLE group would prove to be superior. Similar within group changes were seen between both