|
Title
|
|
|
|
Induce pain to relieve pain : the effect of “exercise into discomfort” on clinical outcomes and ultrasound imaging parameters in patients with subacromial shoulder pain
| |
|
Author
|
|
|
|
| |
|
Abstract
|
|
|
|
| Subacromial shoulder pain (SSP) is a common musculoskeletal complaint, often triggered by overhead movements. SSP can result from extrinsic factors like external compression of the rotator cuff (RC) during arm elevation or intrinsic factors such as changes in the RC’s load capacity. Conservative treatments, particularly exercise therapy, are recommended. The debate continues on whether exercises should be painful or not, as painful exercises might increase exercise-induced hypoalgesia and improve self-efficacy. Ultrasound (US) can help to investigate the subacromial (acromiohumeral distance, AHD) and subcoracoid (coracohumeral distance, CHD) spaces. While a reduction in AHD might indicate an extrinsic cause of SSP, the relationship between symptoms and AHD is inconsistent. The role of CHD and RC interval tendons in SSP has still to be investigated. US is operator-dependent, requiring proper training to ensure reliability. Further research is needed to explore the association of US changes with symptom improvement. This PhD project aimed to address four key objectives: 1) evaluating the feasibility of exercising into pain for SSP patients; 2) assessing the reliability of a novice US examiner in measuring AHD, CHD, and RC interval tendons; 3) comparing the effects of painful versus non-painful exercises in a randomized controlled trial (RCT) on patient-reported and physical outcomes over a 12-week program with a six-month follow-up; 4) analysing the US outcomes collected during the RCT and exploring the correlation between changes in US measures and symptoms after six months. The feasibility study revealed high attendance at physiotherapy sessions but low adherence to home exercises. Only 57% of patients engaged in painful exercises, and physiotherapists faced difficulties in maintaining pain-provoking exercises over time. Consequently, the RCT was adjusted to include just one painful exercise, with the rate of perceived exertion being used instead of a numeric pain scale when necessary. The reliability studies showed high intra-rater reliability for a novice US examiner but poor-to-good inter-rater reliability compared to an expert, highlighting the need for thorough training. CHD measurements demonstrated high reliability and should be investigated in future research. The RCT results showed no significant differences between painful and non-painful exercise groups in improving clinical, physical, or US outcomes. However, all participants experienced considerable improvements in pain, disability, quality of life, strength, and range of motion. The findings suggest that painful exercises are not essential for symptom improvement, emphasizing the importance of other factors (psychological, contextual aspects) in rehabilitation. |
| |
|
Language
|
|
|
|
English
| |
|
Publication
|
|
|
|
Antwerp
:
University of Antwerp, Faculty of Medicine and Health Sciences
,
2024
| |
|
DOI
|
|
|
|
10.63028/10067/2080660151162165141
| |
|
Volume/pages
|
|
|
|
251 p.
| |
|
Note
|
|
|
|
:
Struyf, Filip [Supervisor]
:
Luque-Suarez, Alejandro [Supervisor]
| |
|
Full text (open access)
|
|
|
|
| |
|