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The purpose of this study is to understand acute tendon changes after two exercise programs. We will invite individuals with and without shoulder pain to participate in this study. Every individual will participate in both exercise programs separated by up to 15 days. The researcher will evaluate the shoulder tendon using ultrasound before each exercise program and at 1 hour, 6 hours and 24 hours after each exercise program. The researcher will also evaluate self reported pain, pain sensitivity testing, and self reported questionnaires. We will compare the tendon changes after each exercise program, as well as between participants with and without shoulder pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Isotonic exercise then Plyometric exercise | Experimental |
| |
| Plyometric exercise then Isotonic exercise | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Isotonic exercise program | Behavioral | Participants will perform two isotonic exercises, prone shoulder external rotation and shoulder elevation. The exercises will be performed at a pace of 2-second for both concentric and eccentric phases. For each exercise, participants will perform two sets of 8 repetitions, followed by a third set performed until fatigue. Fatigue will be determined using the Repetition in Reserve Scale, which asks the participant to perform exercises until they reach a self-selected number corresponding to the number of repetitions left that a participant could still complete if needed. We will ask participants to continue the third set until they reach a Repetition in Reserve number of 1. The rest period will be 30 seconds between sets and 2 minutes between exercises. The exercise load will be selected after manual maximal isometric strength testing using a handheld dynamometer. A 40% of the strength testing will be used for exercises in both groups following strength guidelines. |
| Measure | Description | Time Frame |
|---|---|---|
| Supraspinatus tendon thickness | The investigators will use ultrasound to take pictures of the supraspinatus tendons. Established ultrasound procedures will be used to measure supraspinatus tendon thickness. | From enrollment to 1 hour, 6 hours, and 24 hours after each exercise program. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain sensitivity testing | The investigators will apply pressure at a constant rate using a computerized pressure algometer with a 1 cm diameter rubber tip at the shoulder and the lower limb. | From enrollment to 1 hour, 6 hours, and 24 hours after each exercise program. |
| Self-reported pain |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of perceived exertion | We will use a 11-point scale, 0 being no effort and 10 being the maximal effort, to understand the effort perceived after each exercise program. | Immediately after each exercise program. |
| Pennsylvania Shoulder Score (PENN) |
General inclusion criteria
General exclusion criteria
Group-specific inclusion criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ignacio A Raguzzi, PT | Contact | 352-665-4947 | iraguzzi@ufl.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Florida | Recruiting | Gainesville | Florida | 32610 | United States |
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Study protocol & statistical analysis plan: A manuscript describing the study protocol and statistical analysis plan will be submitted for publication before the end of the recruitment for the study.
Study protocol and statistical analysis plan: The manuscript will be published as open access.
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| ID | Term |
|---|---|
| D020069 | Shoulder Pain |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D010146 | Pain |
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The cross-over randomized clinical trial will have two exercise exposures (plyometric and isotonic). We will recruit individuals with and without shoulder pain. Both groups will perform each exercise exposure. In between the two exposures, each group will have a washout period of one week (± 3 days). Outcomes will be collected before each exercise exposure (baseline 1 and baseline 2), and after each exercise exposure (follow-up assessment 1 and 2). Each follow-up assessment involves data collection at three time points: 1 hour, 6 hours, and 24 hours after the exercise exposure.
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|
| Plyometric exercise program | Behavioral | Participants will perform two isotonic exercises, prone shoulder external rotation and shoulder elevation. The exercises will be performed at a pace of 1-second for the eccentric phases followed by an explosive concentric phase. For each exercise, participants will perform two sets of 8 repetitions, followed by a third set performed until fatigue. Fatigue will be determined using the Repetition in Reserve Scale, which asks the participant to perform exercises until they reach a self-selected number corresponding to the number of repetitions left that a participant could still complete if needed. Participants will complete the third set until they reach a Repetition in Reserve number of 1. The rest period will be 30 seconds between sets and 2 minutes between exercises. The exercise load will be selected after manual maximal isometric strength testing using a handheld dynamometer. A 40% of the strength testing will be used for exercises in both groups following strength guidelines. |
|
We will use an 11-point numeric pain rating scale to measure the shoulder pain perceived by the participant. |
| From enrollment to 1, 6, and 24 hours after each exercise program. |
The PENN is a valid and reliable self-reported questionnaire for patients with shoulder pain.
| At baseline before each exercise program. |
| Optimal Screening for Prediction of Referral and Outcome (OSPRO) | The OSPRO is a concise, multidimensional 10-item yellow flag assessment tool that estimates 11 total questionnaire scores indicating elevated vulnerability and decreased resilience. | At baseline before the first exercise program. |
| Global rating of change (GROC) | The GROC is a rating scale that quantifies participants' improvement or deterioration of symptoms over time. Changes will be measured using a 15-points Likert scale (-7, a very great deal worse to 7, a very great deal better, with 0 indicating no changes). | At the second baseline before the second exercise program at 1 week. |
| Tegner Activity Scale | Is a valid and reliable tool that evaluates work and sport participation. It addresses both function and activity level, and it will provide information about the physical general activity of the individual. | At baseline before the first exercise program. |
| Rate of perceived fatigue | We will use a 11-point scale, 0 being no fatigue and 10 being the maximal fatigue, to understand the fatigue perceived after each exercise program. | Immediately after each exercise program |
| Self-reported pain related to the exercise | We will use an 11-point numeric pain rating scale to measure the shoulder pain perceived by the participant. | Before and immediately after each exercise program |
| Muscle soreness | We will use an 11-point numeric rating scale to measure the muscle soreness perceived by the participant after the exercise. | Before and immediately, 1, 6 and 24 hours after each exercise program |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001519 | Behavior |