Psychological Influences Predict Recovery Following Exercise Induced Shoulder Pain

Abstract

Predicting recovery following muscle injury can be difficult because it involves consideration of multiple factors. Our objective was to determine if psychological factors, sex, and peak pain and disability ratings could be predictive of delayed recovery following induced muscle injury. Healthy untrained volunteers (n=126; M:F 51:75) underwent a concentric/eccentric isokinetic exercise protocol on their dominant shoulder to induce fatigue, with individuals who reported pain (>0/10) at 96 h being classified as "not recovered". Individuals experiencing pain at 48 h were more likely not to be recovered (O.R.=1.62, p<0.001). Additionally, individuals with higher scores in pain catastrophizing at 48 h were more likely to experience pain at 96 h (O.R.=1.06, p<0.001). Pain duration (in days) was associated with pain scores at 48 h (β=0.385, p<0.001) and baseline anxiety (β=0.220, p=0.007). Fear of movement/re-injury at 96 h was found to be associated with pain catastrophizing at 48 h (β=0.537, p<0.001) and baseline levels of fear of pain (β=0.217, p=0.004). This study provides preliminary evidence that higher pain levels and pain catastrophizing following acute muscle injury are associated with poor recovery, higher fear of movement/re-injury and longer pain duration.

What factors are predictors of emotional health in patients with full-thickness rotator cuff tears?

“…Parr et al confirmed these findings, demonstrating that patients with higher pain-related fear scores and pain catastrophizing had higher reported levels of pain, longer duration of pain, and worse recovery after standardized acute muscle injury. 23 This indicates that the relationship of pain scores and SANE scores and emotional distress, as demonstrated in this study, may not be a truly linear relationship but is a "twoway street. "…”

“…Previous authors have catalogued that a number of psychosocial variables have an effect on patients' perceptions of pain and function. 6,10,11,13,17,23,24 This knowledge as well as extensive research by the WORC group in creating the WORC score led them to create a specific subgroup devoted to emotional parameters, the WORC emotion score. Despite evidence of the importance of the emotional state of the patient with a rotator cuff tear, no study has directly assessed which factors correlate with a better or worse WORC emotion score.…”

“…2,7 In the shoulder, numerous studies have documented the profound impact of biopsychosocial stressors, coping mechanisms, and pain catastrophizing on perception of shoulder pain and disability. 3,6,7,10,11,17,23,24 Emerging data have indicated that biopsychosocial factors may have a dramatic effect on postoperative recovery and final clinical outcomes after surgical repair of rotator cuff tears. 13,26 To date, there have been no large studies to document predictors of poor emotional health in patients with full-thickness rotator cuff tears (FTRCTs).…”

Prolonged Reduction in Shoulder Strength after Transcutaneous Electrical Nerve Stimulation Treatment of Exercise‐Induced Acute Muscle Pain

“…Exercise continued until participants could only generate 50% of their original shoulder external rotation maximum voluntary isometric contraction (MVIC). Previous studies have used 50% MVIC as a level indicating fatigue in the shoulder; furthermore, our group has successfully used this protocol in prior studies to induce DOMS, specifically in the shoulder …”

Range of Motion as a Predictor of Clinical Shoulder Pain During Recovery From Delayed-Onset Muscle Soreness

“…The isokinetic exercise protocol was based on other studies 19,22,23 using similar equipment and had been previously used in our laboratory. [24][25][26] Participants were placed in the Kin-Com in an upright seated position with the torso strapped into the chair to isolate movement of the dominant shoulder. Two straps crossed the participant's torso and an additional strap crossed the lap to limit all movement per the manufacturer's recommendations.…”