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Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomized controlled trial
Chaconas EJ, Kolber MJ, Hanney WJ, Daugherty ML, Wilson SH, Sheets C
International Journal of Sports Physical Therapy 2017 Dec;12(7):1121-1133
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Shoulder pain affects up to 67% of the population at some point in their lifetime with subacromial pain syndrome (SAPS) representing a common etiology. Despite a plethora of studies there remains conflicting evidence for appropriate management of SAPS. PURPOSE: To compare outcomes, for individuals diagnosed with SAPS, performing a 6-week protocol of eccentric training of the shoulder external rotators (ETER) compared to a general exercise (GE) protocol. STUDY DESIGN: Randomized controlled trial. METHODS: Forty-eight individuals (mean age 46.8 years +/- 17.29) with chronic shoulder pain, and a clinical diagnosis of SAPS were randomized into either an experimental group performing ETER or a control group performing a GE program. The intervention lasted for six weeks, and outcomes were measured after three weeks, six weeks, and again at six months post intervention. RESULTS: The primary outcome of function, measured by the Western Ontario Rotator Cuff Index, demonstrated a significant interaction effect derived from a multilevel hierarchical model accounting for repeated measures favoring the experimental group at week 3 14.65 (p = 0.003), week 6 17.04 (p < 0.001) and six months 15.12 (p = 0.007). After six months, secondary outcome measures were improved for numeric pain rating scale levels representing pain at worst (p = 0.006) and pain on average (p = 0.02), external rotator (p < 0.001), internal rotator (p = 0.02), and abductor strength (p < 0.001). There were no statistically significant differences in secondary outcome measures of Global Rating of Change, active range of motion, the Upper Quarter Y Balance Test and strength ratios after six months. CONCLUSION: An eccentric program targeting the external rotators was superior to a general exercise program for strength, pain, and function after six months. The findings suggest eccentric training may be efficacious to improve self-report function and strength for those with SAPS. LEVEL OF EVIDENCE: 2b.

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