Tolerance and effectiveness of eccentric vs. concentric muscle strengthening in rotator cuff partial tears and moderate to severe shoulder pain. A randomized pilot study

Abstract

Introduction: Rotator cuff tears are the main cause of shoulder pain and disability. First line of treatment is conservative; there is evidence regarding the advantage of using eccentric over concentric exercises in tendinopathies, but there are no evidence-based recommendations on starting strengthening exercise during painful phases nor on the effectiveness and advantages of eccentric vs. concentric exercise in rotator cuff tears. Objective: To evaluate the tolerance of a resistance strengthening program and to compare eccentric vs. concentric programs. Design: A pilot, experimental, randomized controlled study. Setting: Outpatient Rehabilitation Center. Patients: Twenty-six patients with a diagnosis of partial rotator cuff tear were randomly assigned to: the experimental group (eccentric, n ¼ 12) and the control (concentric, n ¼ 14). Intervention: The experimental group performed muscle strengthening with eccentric technique directed to shoulder and scapular girdle muscles, while the control group performed the concentric technique. Main outcome measures.: Visual Analogue Scale (VAS), Constant Scale, Strength, Structure (Ultrasound report). Results: The tolerance rate was 96% in both groups. Median age (experimental vs. control) was 54.5 vs. 54 years (p ¼ 0.69

Eccentric Contraction Enhances Healing of the Bone-Tendon Interface After Rotator Cuff Repair in Mice

“…11,19 Concurrently, numerous studies have shown that eccentric training is effective in preventing muscle sprains, recovering from muscle atrophy, and treating tendon pain. 34,41 Our study demonstrated that exercise stimulation with different muscle contraction patterns can initially regulate macrophages according to the magnitude of the inflammatory response at the injury site, resulting in different states of fibroblast proliferation, cytoplasmic matrix deposition, and growth factor concentration, and demonstrating the benefits of eccentric muscle contraction.…”

Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review

“…Regarding the Level of Evidence, 5 studies were level I RCTs 30,31,34,37,38 ; 5 level III PCC studies 7,8,32,33,42 ; and 1 level IV prospective case-series study 36 …”

“…Regarding the Level of Evidence, 5 studies were level I RCTs 30,31,34,37,38 ; 5 level III PCC studies 7,8,32,33,42 ; and 1 level IV prospective case-series study. 36 The 11 studies reviewed included a total of 454 patients, with a minimum follow-up of 3 months.…”

“…In this systematic review, all the RCTs included were rated as having a "low risk of bias." 30,31,34,37,38 Among the 6 case-control studies (CCs) examined, 4 were classified as "low risk of bias," 7,32,35,36 while 2 were categorized as "moderate risk of bias." 8,33 None of the CCs were identified as having a serious or critical risk of bias.…”

Lesiones de manguito rotador: estado actual de la literatura con enfoque en rehabilitación

“…44 Macías-Hernández y colaboradores publicaron un artículo en el que compararon un programa de rehabilitación que incluyó, termoterapia, ejercicios de movilidad, estiramiento y fortalecimiento excéntrico versus concéntrico en pacientes con lesiones parciales de MR en fases dolorosas, donde mostraron una adecuada tolerancia del fortalecimiento, mejoría en el dolor y la funcionalidad en ambos grupos, sin diferencias significativas entre ellos. 45 De forma general se recomienda comenzar con un tratamiento conservador de 12 semanas, para poder evaluar adecuadamente el resultado. Los protocolos publicados son heterogéneos, pero generalmente se progresan de forma mensual.…”