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The aim of this study is to compare the immediate effects of an acute bout of isometric exercise of the shoulder external rotator muscles above and below pain threshold on pain intensity, pain threshold, conditioned pain modulation and pain free force in external rotation. To evaluate the results of the exercise, the subjects will be assessed at pre-intervention, immediately post-intervention and after and 45 minutes after each experimental condition.
The aim of this study is to compare the immediate effects of an acute bout of isometric exercise of the shoulder external rotator muscles above and below pain threshold on pain intensity, pain threshold, conditioned pain modulation and pain free force in external rotation.
It will consist of a randomized three-treatment parallel-design study. The sample will consist of subjects with rotator cuff related shoulder pain (RCRSP). Once the sample is selected, subjects will participate in three experimental sessions, which will occur in a randomized order: two exercise sessions (supra-threshold and infra-threshold isometric exercise) and one control session. In the first session, information regarding clinical and demographical aspects will be collected. A washout period of approximately 48 hours will separate each of the experimental sessions.
To evaluate the results of the exercise, the subjects will be assessed at pre-intervention, immediately post-intervention and 45 minutes after each experimental condition. Pain intensity, Pressure Pain Thresholds (PPT), Conditioned Pain Modulation (CPM), maximal voluntary isometric contraction (MVIC) and pain free isometric strength (PFIS) will be measured.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Supra-threshold isometric exercise | Experimental | Participants will perform 10 isometric external rotation supra-threshold contractions of the affected shoulder, each held for 15 seconds, with resting intervals of 15 seconds between contractions. |
|
| Infra-threshold isometric exercise | Experimental | Participants will perform 10 isometric external rotation infra-threshold contractions of the affected shoulder, each held for 15 seconds, with resting intervals of 15 seconds between contractions. |
|
| Control | No Intervention | Participants will remain resting. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Supra-threshold isometric exercise | Other | The supra-threshold intensity will be stablished at 120% of participant's PFIS pre-session measurement (20% above the individual's pain threshold). |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity | Shoulder pain intensity reported by the patient will be assessed using a 100-mm visual analogue scale (VAS, 0-100, 0=minimum score, 100=maximum score). Higher values represent a better outcome (less pain). | Baseline |
| Pain intensity | Shoulder pain intensity reported by the patient will be assessed using a 100-mm visual analogue scale (VAS, 0-100, 0=minimum score, 100=maximum score). Higher values represent a better outcome (less pain). | Immediately post-intervention |
| Pain intensity | Shoulder pain intensity reported by the patient will be assessed using a 100-mm visual analogue scale (VAS, 0-100, 0=minimum score, 100=maximum score). Lower values represent a better outcome (less pain). | 45 minutes post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Pressure Pain Thresholds (PPT) | PPTs will be recorded using an electronic algometer at the ipsilateral m. infraspinatus, the contralateral resting m. infraspinatus and the contralateral resting m. quadriceps. Higher values represent a better outcome. | Baseline, immediately post-intervention and 45 minutes post-intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mercè Balasch i Bernat, PhD | Universitat de València | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mercè Balasch i Bernat | Valencia | Valencia | 46021 | Spain | ||
| Mercè Balasch i Bernat |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15163107 | Background | Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi: 10.1080/03009740310004667. | |
| 28572848 | Background | Watts AR, Williams B, Kim SW, Bramwell DC, Krishnan J. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria. Shoulder Elbow. 2017 Jan;9(1):31-41. doi: 10.1177/1758573216663201. Epub 2016 Aug 20. |
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| ID | Term |
|---|---|
| D000070636 | Rotator Cuff Injuries |
| ID | Term |
|---|---|
| D012421 | Rupture |
| D014947 | Wounds and Injuries |
| D000070599 | Shoulder Injuries |
| D013708 | Tendon Injuries |
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Exercise sessions were delivered by a physiotherapist who was not involved in the assessments.
| Infra-threshold isometric exercise | Other | The infra-threshold intensity will be stablished at 80% of participant's PFIS pre-session measurement (20% bellow the individual's pain threshold). |
|
| Pressure Pain Thresholds (PPT) |
PPTs will be recorded using an electronic algometer at the ipsilateral m. infraspinatus, the contralateral resting m. infraspinatus and the contralateral resting m. quadriceps. Higher values represent a better outcome. |
| Immediately post-intervention |
| Pressure Pain Thresholds (PPT) | PPTs will be recorded using an electronic algometer at the ipsilateral m. infraspinatus, the contralateral resting m. infraspinatus and the contralateral resting m. quadriceps. Higher values represent a better outcome. | 45 minutes post-intervention |
| Conditioned pain modulation (CPM) | CPM will be tested using the upper extremity submaximal effort tourniquet test. | Baseline |
| Conditioned pain modulation (CPM) | CPM will be tested using the upper extremity submaximal effort tourniquet test. | Immediately post-intervention |
| Conditioned pain modulation (CPM) | CPM will be tested using the upper extremity submaximal effort tourniquet test. | 45 minutes post-intervention |
| Maximal voluntary isometric contraction (MVIC) | MVIC will be measured at both m. infraspinatus and m. quadriceps of the non-affected side using a digital force gauge. | Baseline |
| Maximal voluntary isometric contraction (MVIC) | MVIC will be measured at both m. infraspinatus and m. quadriceps of the non-affected side using a digital force gauge. | Immediately post-intervention and 45 minutes post-intervention |
| Maximal voluntary isometric contraction (MVIC) | MVIC will be measured at both m. infraspinatus and m. quadriceps of the non-affected side using a digital force gauge. | 45 minutes post-intervention |
| Pain free isometric strength/threshold (PFIS) | PFIS will be assessed at m. infraspinatus of the affected shoulder | Baseline |
| Pain free isometric strength/threshold (PFIS) | PFIS will be assessed at m. infraspinatus of the affected shoulder | Immediately post-intervention |
| Pain free isometric strength/threshold (PFIS) | PFIS will be assessed at m. infraspinatus of the affected shoulder | 45 minutes post-intervention |
| Valencia |
| 46021 |
| Spain |
| 22581193 | Background | Maenhout AG, Mahieu NN, De Muynck M, De Wilde LF, Cools AM. Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial. Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1158-67. doi: 10.1007/s00167-012-2012-8. Epub 2012 May 12. |
| 15862727 | Result | Luime JJ, Koes BW, Miedem HS, Verhaar JA, Burdorf A. High incidence and recurrence of shoulder and neck pain in nursing home employees was demonstrated during a 2-year follow-up. J Clin Epidemiol. 2005 Apr;58(4):407-13. doi: 10.1016/j.jclinepi.2004.01.022. |
| 27083390 | Result | Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016 Jun;23:57-68. doi: 10.1016/j.math.2016.03.009. Epub 2016 Mar 26. |
| 25715230 | Result | Littlewood C, Malliaras P, Chance-Larsen K. Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. Int J Rehabil Res. 2015 Jun;38(2):95-106. doi: 10.1097/MRR.0000000000000113. |
| 22507359 | Result | Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012 Jun;98(2):101-9. doi: 10.1016/j.physio.2011.08.002. Epub 2011 Oct 5. |
| 28596288 | Result | Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(23):1679-1687. doi: 10.1136/bjsports-2016-097383. Epub 2017 Jun 8. |
| 22349588 | Result | Holmgren T, Bjornsson Hallgren H, Oberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012 Feb 20;344:e787. doi: 10.1136/bmj.e787. |
| 26160149 | Result | Littlewood C, Bateman M, Brown K, Bury J, Mawson S, May S, Walters SJ. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clin Rehabil. 2016 Jul;30(7):686-96. doi: 10.1177/0269215515593784. Epub 2015 Jul 9. |
| 26889612 | Result | Coombes BK, Wiebusch M, Heales L, Stephenson A, Vicenzino B. Isometric Exercise Above but not Below an Individual's Pain Threshold Influences Pain Perception in People With Lateral Epicondylalgia. Clin J Pain. 2016 Dec;32(12):1069-1075. doi: 10.1097/AJP.0000000000000365. |
| 23141188 | Result | Naugle KM, Fillingim RB, Riley JL 3rd. A meta-analytic review of the hypoalgesic effects of exercise. J Pain. 2012 Dec;13(12):1139-50. doi: 10.1016/j.jpain.2012.09.006. Epub 2012 Nov 8. |
| 25979840 | Result | Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, Cook J. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015 Oct;49(19):1277-83. doi: 10.1136/bjsports-2014-094386. Epub 2015 May 15. |
| 33887445 | Derived | Balasch-Bernat M, Lluch E, Vaegter HB, Duenas L. Should Exercises be Painful or not? Effects on Clinical and Experimental Pain in Individuals with Shoulder Pain. J Pain. 2021 Oct;22(10):1246-1255. doi: 10.1016/j.jpain.2021.03.153. Epub 2021 Apr 20. |