The rotator cuff consists of four muscles and tendons located in the shoulder area. Between 7 and 26% of the general population is affected by shoulder disorders. Dr. Roy and Dr. Desmeules provide more details in this short video, discussing the ups and downs of developing a clinical practice guide to facilitate the return to work of people with rotator cuff injuries. Their research team also looked at the impact of education and advice and specific exercises to manage shoulder pain. Indeed, education and advice should not be underestimated as a stand-alone intervention in the management of rotator cuff-related shoulder pain.
Goal
The objective of this randomized controlled trial was to compare three different ways of managing rotator cuff related shoulder pain: 1) Education only; 2) Education combined with motor control exercises; 3) Education combined with strengthening exercises. The research team aimed to evaluate if one of these three frequently used interventions could lead to a greater pain and/or symptoms reduction. We also aimed to evaluate if the interventions led to different results regarding shoulder muscles strength and psychological characteristics associated with persistent pain.
Methodology
123 individuals presenting with rotator cuff-related shoulder pain for the past three months at least were recruited to take part in this project. They were randomly allocated to one of three interventions lasting 12 weeks.
Education only: Participants in this group took part in an initial 30-minute session with a physiotherapist, where they received information on their shoulder pain and, their pain and advice on activity modification and on the importance of healthy lifestyle choices (hydration, nutrition, sleep, physical activity, stress management). They also had to watch six short videos at home on those topics before discussing them with the physiotherapist during a second 30-minute session where any of their remaining questions were answered.
Education combined with motor control exercises: In addition to the same education intervention given to the first group, participants in this group underwent an exercise program aiming to change the way they move their arm in order to allow for a less painful movement and to reduce potential compensations.
Education combined with strengthening exercises: In addition to the same education intervention given to the first two groups, participants in this group received an exercise program aiming to potentially increase strength through higher loads.
To measure their evolution over time, participants filled out self-administered questionnaires evaluating their pain, their symptoms, and their functional level.
Main findings
All three interventions (education only; education combined with motor control exercises; education combined with strengthening exercises) were effective in improving symptoms and functional limitations in individuals with rotator cuff-related shoulder pain. However, the addition of motor control or strengthening exercises did not lead to significantly better results than an intervention comprising education and advice only.
Take home message
Clinicians and individuals living with persistent rotator cuff-related shoulder pain should consider education and advice as the first intervention to resort to for the management of this condition. Even though the addition of exercises to education did not lead to additional benefits compared to education alone, exercises remain a relevant low-cost and low-harm intervention. Future studies should attempt to highlight if characteristics can help clinicians identify which patients will benefit the most from the addition of exercises and which patients could only require education and advice. Dr. Roy and Dr. Desmeules invite you to watch this short video presenting the ups and downs of developing a clinical practice guideline to facilitate the return to work of people with rotator cuff injuries.
Or reach out to Marc-Olivier Dubé, physiotherapist and PhD candidate at the Center for Interdisciplinary Research in Rehabilitation and Social Integration and Université Laval : marc-olivier.duve.1@ulaval.ca, Twitter (marco_dube)
