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Exercise strategies in subacromial pain syndrome

Is there an added value of specific exercises?

Despite the large amount of research on exercise strategies for treating patients with subacromial pain syndrome (SPS), the evidence for using specific exercises rather than general exercises in rehabilitation is insufficient.

This the conclusion of a recent systematic review, which included 6 randomised controlled trials (RCTs) totalling 231 participants with SPS. Both qualitative and quantitative analyses were performed to synthesise the available data.

Synthesis of best evidence learned that there is either insufficient or conflicting evidence for the use of specific exercise strategies for improving pain, function, general strength and proprioception. There is, however, limited evidence for specifically training the scapular stabilisers. No evidence was found that specific exercises could increase ROM.

A quantitative analysis was also performed. For neither pain nor function, a significant effect of specific exercises was found. Due to heterogeneity of the studies, pooling of data was not possible for outcome measures regarding strength, proprioception and ROM.

The authors state that inconsistencies and lack of methodological quality are limiting the conclusions that can be drawn based on the available evidence. Therefore, no recommendations are included either about exercise parameters (e.g., type, frequency, volume and intensity).

> From: Shire et al., BMC Musculoskelet Disord 18 (2017) 158 . All rights reserved to The Author(s). Click here for the online summary.

Expert opinion by Willem-Paul Wiertz

Although the authors seem to attribute the absence of evidence in favour of specific exercise strategies to the heterogeneity and methodological quality of the included RCTs, the conclusions of this systematic review and meta-analysis in line with research into specific exercises.

In populations with low back and neck pain, the added value (or superiority) of motor control exercises to improve neuromuscular control and coordinator of deep stabilizing muscles of the spine could not be demonstrated.

This gives rise to a lot of questions. Does it matter which exercises we prescribe, or is it okay as long as we stimulate the patient to move actively? Will more simplified programs do the trick as well? How much exercise specificity can we sacrifice for the sake of compliance?

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