Effectiveness of Eccentric and Concentric Strength Training in Patients With Subacromial Impingement Syndrome

Study Overview
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Brief Summary
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The purpose of this study is to investigate and compare the effects of eccentric and concentric strength training on pain, strength, joint position sense and function in patients with subacromial impingement syndrome.

Official Title
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Effectiveness of Eccentric and Concentric Strength Training in Patients With Subacromial Impingement Syndrome: A Randomized Controlled Trial

Conditions
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Subacromial Impingement Syndrome

Intervention / Treatment
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* Other: Eccentric training
* Other: Concentric training
* Other: Standard physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of subacromial impingement syndrome Complaints associated with subacromial impingement syndrome for at least 3 months No extra pain with 90 degree abduction-90 degree external rotation position of the shoulder Ability to complete the entire study procedure Exclusion Criteria: Severe pain; shoulder pain is > 7/10 History of upper extremity fracture History of shoulder, cervical and thoracic surgery Having shoulder instability or frozen shoulder diagnosis History of shoulder injuries, trauma and / or shoulder symptoms requiring treatment during the last 1 year (except than subacromial impingement syndrome) Full-thickness rotator cuff tear Systemic musculoskeletal disease Neck and shoulder pain with cervical spine movement Chest deformity or scoliosis diagnosis

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Eccentric training group<br>The participants in this group will actively perform eccentric phase of resistive shoulder exercises. Additionally they will receive standard physiotherapy. | Other: Eccentric training<br>* Eccentric phase of resistive shoulder exercises will be performed three sets of 15 repetitions once a day for 12 weeks using therabands. Participants will be supervised by the physiotherapist 3 days a week for the first 6 weeks, 2 days a week for the next 3 weeks and 1 day a week for the last 3 weeks.<br>Other: Standard physiotherapy<br>* The participants will receive standard physiotherapy. The standard physiotherapy exercises will be supervised by the physiotherapist, same as intervention exercises.<br>|
| Experimental: Concentric training group<br>The participants in this group will actively perform concentric phase of resistive shoulder exercises. Additionally they will receive standard physiotherapy. | Other: Concentric training<br>* Concentric phase of resistive shoulder exercises will be performed three sets of 15 repetitions once a day for 12 weeks using therabands. Participants will be supervised by the physiotherapist 3 days a week for the first 6 weeks, 2 days a week for the next 3 weeks and 1 day a week for the last 3 weeks.<br>Other: Standard physiotherapy<br>* The participants will receive standard physiotherapy. The standard physiotherapy exercises will be supervised by the physiotherapist, same as intervention exercises.<br>|
| Active Comparator: Control group<br>The participants in this group will receive only standard physiotherapy. | Other: Standard physiotherapy<br>* The participants will receive standard physiotherapy. The standard physiotherapy exercises will be supervised by the physiotherapist, same as intervention exercises.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder Function | Change of Constant Murley Score | Baseline, 12 weeks and 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity | Change of visual analog scale score in activity and rest | Baseline, 12 weeks and 24 weeks | 
| Upper extremity function | Change of disabilities of the arm, shoulder, and hand (DASH) score | Baseline, 12 weeks and 24 weeks | 
| Isometric strength | Change of shoulder abduction and external rotation isometric strength (in kg, with hand held dynamometer) | Baseline, 12 weeks and 24 weeks | 
| Eccentric strength | Change of shoulder abduction and external rotation eccentric strength (in kg, with hand held dynamometer) | Baseline, 12 weeks and 24 weeks | 
| Joint position sense | Change of shoulder joint repositioning angle errors (with bubble inclinometer) | Baseline, 12 weeks and 24 weeks |