Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial

Abstract

Background:Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated.Purpose:To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population.Results:A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically nonsignificant adjusted mean group difference of −1.37 points (95% CI, −6.72 to 3.99; P = .61). Similar nonsignificant results were seen for pain, range of motion, and strength. However, a significant interaction effect was found between the 2 groups and concomitant corticosteroid use (P = .028), with the largest positive change in DASH in favor of PHLE for the group receiving concomitant corticosteroid.Conclusion:The study results showed no superior benefit from PHLE over traditional LLE among patients with rotator cuff tendinopathy. Further investigation of the possible interaction between exercise type and corticosteroid injection is needed to establish optimal and potentially synergistic combinations of these 2 factors.Registration:NCT01984203 (ClinicalTrials.gov identifier): Rotator Cuff Tendinopathy Exercise Trial (RoCTEx).

Feasibility of Heavy Slow Resistance Training in patients with subacromial shoulder pain. A single-blind, randomized pilot study.

“…Exercise type may be specified for each patient individually. This is previously discussed briefly by other authors 13,22,23 . The results of the current study suggest that different treatment methods may have a positive effect.…”

Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study)

“…A home-based shoulder exercise programme with instructions for individual tailoring, described in a pamphlet (Additional file 2). Exercises for treating shoulder complaints have shown promising results [23][24][25][26], but the optimal type, intensity, frequency, and duration of these exercises are not clear [27][28][29][30][31]. Our exercise programme was constructed by JT in cooperation with three physiotherapists from the orthopaedic shoulder department at Silkeborg Regional Hospital (SRH).…”

“…Our exercise programme was constructed by JT in cooperation with three physiotherapists from the orthopaedic shoulder department at Silkeborg Regional Hospital (SRH). Based on studies showing effect of exercise programmes [23][24][25][26]32], easily learned exercises were selected taking into account elements known to motivate exercise adherence (e.g. a limited number of exercises) [33].…”

Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study)

“…A home-based shoulder exercise programme with instructions for individual tailoring, described in a pamphlet (Additional file 2). Exercises for treating shoulder complaints have shown promising results [25,[36][37][38], but the optimal type, intensity, frequency, and duration of these exercises are not clear [39][40][41][42][43]. Our exercise programme was constructed by JT in cooperation with three physiotherapists from the orthopaedic shoulder department at Silkeborg Regional Hospital (SRH).…”

“…Our exercise programme was constructed by JT in cooperation with three physiotherapists from the orthopaedic shoulder department at Silkeborg Regional Hospital (SRH). Based on studies showing effect of exercise programmes [25,[36][37][38]44], easily learned exercises were selected taking into account elements known to motivate exercise adherence (e.g. a limited number of exercises) [45].…”