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Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome?: a randomized, clinical trial

Annelies Maenhout (UGent) , Nele Mahieu (UGent) , Martine De Muynck (UGent) , Lieven De Wilde (UGent) and Ann Cools (UGent)
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Abstract
To investigate superior value of adding heavy load eccentric training to conservative treatment in patients with subacromial impingement. Sixty-one patients with subacromial impingement were included and randomly allocated to the traditional rotator cuff training (TT) group (n = 30, mean age = 39.4 +/- A 13.1 years) or traditional rotator training combined with heavy load eccentric training (TT + ET) group (n = 31, mean age = 40.2 +/- A 12.9 years). Isometric strength was measured to abduction at 0A degrees, 45A degrees and 90A degrees of scapular abduction and to internal and external rotation. The SPADI questionnaire was used to measure shoulder pain and function. Patients rated subjective perception of improvement. Outcome was assessed at baseline, at 6 and 12 weeks after start of the intervention. Both groups received 9 physiotherapy treatments over 12 weeks. At home, the TT group performed traditional rotator cuff strengthening exercises 1x/day. The TT + ET group performed the same exercises 1x/day and a heavy load eccentric exercise 2x/day. After treatment, isometric strength had significantly increased in all directions, and SPADI score had significantly decreased. The TT + ET group showed a 15 % higher gain in abduction strength at 90A degrees of scapular abduction. Chi-square tests showed patients' self-rated perception of improvement was similar in both groups. Adding heavy load eccentric training resulted in a higher gain in isometric strength at 90A degrees of scapular abduction, but was not superior for decreasing pain and improving shoulder function. This study showed that the combination of a limited amount of physiotherapy sessions combined with a daily home exercise programme is highly effective in patients with impingement.
Keywords
SHOULDER IMPINGEMENT, ROTATOR CUFF TENDINOPATHY, CHRONIC ACHILLES TENDINOSIS, Tendon, Eccentric training, Shoulder impingement syndrome, Physiotherapy, ANTERIOR ACROMIOPLASTY, DISABILITY INDEX, GENERAL-PRACTICE, PAIN, STRENGTH, EXERCISE, TENDON

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MLA
Maenhout, Annelies, et al. “Does Adding Heavy Load Eccentric Training to Rehabilitation of Patients with Unilateral Subacromial Impingement Result in Better Outcome?: A Randomized, Clinical Trial.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, vol. 21, no. 5, 2013, pp. 1158–67, doi:10.1007/s00167-012-2012-8.
APA
Maenhout, A., Mahieu, N., De Muynck, M., De Wilde, L., & Cools, A. (2013). Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome?: a randomized, clinical trial. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 21(5), 1158–1167. https://doi.org/10.1007/s00167-012-2012-8
Chicago author-date
Maenhout, Annelies, Nele Mahieu, Martine De Muynck, Lieven De Wilde, and Ann Cools. 2013. “Does Adding Heavy Load Eccentric Training to Rehabilitation of Patients with Unilateral Subacromial Impingement Result in Better Outcome?: A Randomized, Clinical Trial.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 21 (5): 1158–67. https://doi.org/10.1007/s00167-012-2012-8.
Chicago author-date (all authors)
Maenhout, Annelies, Nele Mahieu, Martine De Muynck, Lieven De Wilde, and Ann Cools. 2013. “Does Adding Heavy Load Eccentric Training to Rehabilitation of Patients with Unilateral Subacromial Impingement Result in Better Outcome?: A Randomized, Clinical Trial.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 21 (5): 1158–1167. doi:10.1007/s00167-012-2012-8.
Vancouver
1.
Maenhout A, Mahieu N, De Muynck M, De Wilde L, Cools A. Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome?: a randomized, clinical trial. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2013;21(5):1158–67.
IEEE
[1]
A. Maenhout, N. Mahieu, M. De Muynck, L. De Wilde, and A. Cools, “Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome?: a randomized, clinical trial,” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, vol. 21, no. 5, pp. 1158–1167, 2013.
@article{2711847,
  abstract     = {{To investigate superior value of adding heavy load eccentric training to conservative treatment in patients with subacromial impingement. 
Sixty-one patients with subacromial impingement were included and randomly allocated to the traditional rotator cuff training (TT) group (n = 30, mean age = 39.4 +/- A 13.1 years) or traditional rotator training combined with heavy load eccentric training (TT + ET) group (n = 31, mean age = 40.2 +/- A 12.9 years). Isometric strength was measured to abduction at 0A degrees, 45A degrees and 90A degrees of scapular abduction and to internal and external rotation. The SPADI questionnaire was used to measure shoulder pain and function. Patients rated subjective perception of improvement. Outcome was assessed at baseline, at 6 and 12 weeks after start of the intervention. Both groups received 9 physiotherapy treatments over 12 weeks. At home, the TT group performed traditional rotator cuff strengthening exercises 1x/day. The TT + ET group performed the same exercises 1x/day and a heavy load eccentric exercise 2x/day. 
After treatment, isometric strength had significantly increased in all directions, and SPADI score had significantly decreased. The TT + ET group showed a 15 % higher gain in abduction strength at 90A degrees of scapular abduction. Chi-square tests showed patients' self-rated perception of improvement was similar in both groups. 
Adding heavy load eccentric training resulted in a higher gain in isometric strength at 90A degrees of scapular abduction, but was not superior for decreasing pain and improving shoulder function. This study showed that the combination of a limited amount of physiotherapy sessions combined with a daily home exercise programme is highly effective in patients with impingement.}},
  author       = {{Maenhout, Annelies and Mahieu, Nele and De Muynck, Martine and De Wilde, Lieven and Cools, Ann}},
  issn         = {{0942-2056}},
  journal      = {{KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY}},
  keywords     = {{SHOULDER IMPINGEMENT,ROTATOR CUFF TENDINOPATHY,CHRONIC ACHILLES TENDINOSIS,Tendon,Eccentric training,Shoulder impingement syndrome,Physiotherapy,ANTERIOR ACROMIOPLASTY,DISABILITY INDEX,GENERAL-PRACTICE,PAIN,STRENGTH,EXERCISE,TENDON}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1158--1167}},
  title        = {{Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome?: a randomized, clinical trial}},
  url          = {{http://doi.org/10.1007/s00167-012-2012-8}},
  volume       = {{21}},
  year         = {{2013}},
}

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