Increased shoulder pain across an exercise session and subsequent shoulder exercise: a prospective cohort study

Jeanette Trøstrup, Susanne Wulff Svendsen, Annett Dalbøge, Lone Ramer Mikkelsen, Mette Terp Høybye, Lene Bastrup Jørgensen, Thomas Martin Klebe, Poul Frost, Jeanette Trøstrup, Susanne Wulff Svendsen, Annett Dalbøge, Lone Ramer Mikkelsen, Mette Terp Høybye, Lene Bastrup Jørgensen, Thomas Martin Klebe, Poul Frost

Abstract

Background: Shoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association.

Methods: We conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017-2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2-3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1-3), resistance level (1-3), and time until next exercise session [days]).

Results: At baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0-10). For a 1-cm increase in pain on a visual analogue scale (0-10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were - 1.3 (95% confidence interval [CI] - 3.4 to 0.9), 0.0 (95% CI - 0.1 to 0.0) and - 0.0 (95% CI - 0.1 to 0.0), respectively. Likewise, the time until next exercise session was - 0.6 (95% CI - 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs.

Conclusion: Increased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures.

Trial registration: The trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).

Keywords: Adherence; Fear-avoidance beliefs; Rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Distribution of weekly exercise sessions according to intervention week (n = 79). The participants performed a total of 1401 exercise sessions during 850 intervention weeks. The number of participants under intervention decreased gradually from 79 in week 7 to 5 in week 15
Fig. 3
Fig. 3
Distribution of pain change across exercise sessions (n = 1260) performed by 79 participants according to intervention week. The 79 participants were sorted according to the number of sessions they had performed. They performed 1260 exercise sessions in total. Green dots (n = 28) represent reduced pain after an exercise session (a change of <  − 1 cm), yellow dots (n = 1003) represent unchanged pain (a change of − 1 to 1 cm) and red dots (n = 229) represent increased pain (a change of > 1 cm)

References

    1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population: a systematic review. Scand J Rheumatol. 2004;33:73–81.
    1. Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85:314–322.
    1. Klintberg IH, Cools AM, Holmgren TM, Holzhausen AC, Johansson K, Maenhout AG, et al. Consensus for physiotherapy for shoulder pain. Int Orthop. 2015;39:715–720.
    1. Kulkarni R, Gibson J, Brownson P, Thomas M, Rangan A, Carr AJ, et al. Subacromial shoulder pain. Shoulder Elbow. 2015;7:135–143.
    1. Sundhedsstyrelsen [Danish Health Authority]. [In Danish] Behandling af patienter med subakromielt smertesyndrom i skulderen [Treatment of patients with subacromial pain syndrome in the shoulder]. Copenhagen: Sundhedsstyrelsen; 2021.
    1. Gutierrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C, Alvarez-Bueno C, Martinez-Vizcaino V, Cavero-Redondo I. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: a systematic review and meta-analysis. Phys Ther Sport. 2020;41:34–42.
    1. Liaghat B, Ussing A, Petersen BH, Andersen HK, Barfod KW, Jensen MB, et al. Supervised training compared with no training or self-training in patients with subacromial pain syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2021;102:2428–3244.
    1. Littlewood C, Malliaras P, Chance-Larsen K. Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. Int J Rehabil Res. 2015;38:95–106.
    1. Holmgren T, Hallgren HB, Öberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012;344:e787.
    1. Littlewood C, Malliaras P, Mawson S, May S, Walters S. Development of a self-managed loaded exercise programme for rotator cuff tendinopathy. Physiotherapy. 2013;99:358–362.
    1. Littlewood C, Malliaras P, Mawson S, May S, Walters S. Patients with rotator cuff tendinopathy can successfully self-manage, but with certain caveats: a qualitative study. Physiotherapy. 2014;100:80–85.
    1. Sandford FM, Sanders TAB, Lewis JS. Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: a qualitative study. J Hand Ther. 2017;30:193–199.
    1. Turk DC, Wilson HD. Fear of pain as a prognostic factor in chronic pain: conceptual models, assessment, and treatment implications. Curr Pain Headache Rep. 2010;14:88–95.
    1. Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153:1144–1147.
    1. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–168.
    1. Karlsson L, Gerdle B, Takala EP, Andersson G, Larsson B. Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain. SAGE Open Med. 2016;4:2050312116668933.
    1. Sindhu BS, Lehman LA, Tarima S, Bishop MD, Hart DL, Klein MR, et al. Influence of fear-avoidance beliefs on functional status outcomes for people with musculoskeletal conditions of the shoulder. Phys Ther. 2012;92:992–1005.
    1. Kromer TO, Sieben JM, de Bie RA, Bastiaenen CH. Influence of fear-avoidance beliefs on disability in patients with subacromial shoulder pain in primary care: a secondary analysis. Phys Ther. 2014;94:1775–1784.
    1. Trøstrup J, Mikkelsen LR, Frost P, Dalbøge A, Høybye MT, Casper SD, et al. Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Cafe Study) Trials. 2019;20:627.
    1. Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996;78:593–600.
    1. Dawson J, Rogers K, Fitzpatrick R, Carr A. The Oxford Shoulder Score revisited. Arch Orthop Trauma Surg. 2009;129:119–123.
    1. Frich LH, Noergaard PM, Brorson S. Validation of the Danish version of Oxford Shoulder Score. Dan Med Bull. 2011;58:A4335.
    1. Christiansen DH, Frost P, Falla D, Haahr JP, Frich LH, Andrea LC, et al. Effectiveness of standardized physical therapy exercises for patients with difficulty returning to usual activities after decompression surgery for subacromial impingement syndrome: randomized controlled trial. Phys Ther. 2016;96:787–796.
    1. Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, et al. Three months of progressive high-load versus traditional low-load strength training among patients with rotator cuff tendinopathy: primary results from the double-blind randomized cntrolled RoCTEx tial. Orthop J Sports Med. 2017;5:1.
    1. Littlewood C, Bateman M, Brown K, Bury J, Mawson S, May S, et al. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study) Clin Rehabil. 2016;30:686–696.
    1. Peterson MD, Rhea MR, Alvar BA. Applications of the dose-response for muscular strength development: a review of meta-analytic efficacy and reliability for designing training prescription. J Strength Cond Res. 2005;19:950–958.
    1. Babatunde FO, MacDermid JC, MacIntyre N. A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice. Arch Physiother. 2017;6:1.
    1. Andersen LL, Zebis MK. Process evaluation of workplace interventions with physical exercise to reduce musculoskeletal disorders. Int J Rheumatol. 2014;2014:761363.
    1. Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46:964–978.
    1. Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009;90:1898–1903.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804.
    1. Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain. Arch Phys Med Rehabil. 2010;91:1128–1136.
    1. Riley SP, Tafuto V, Cote M, Brismée JM, Wright A, Cook C. Reliability and relationship of the Fear-Avoidance Beliefs Questionnaire with the Shoulder Pain And Disability Index and numeric pain rating scale in patients with shoulder pain. Physiother Theory Pract. 2019;35:464–470.
    1. Trolle N, Christiansen DH. Measurement properties of the Fear-Avoidance Belief Questionnaire for physical activity in patients with shoulder impingement syndrome. Patient Relat Outcome Meas. 2019;10:83–87.
    1. George SZ, Stryker SE. Fear-avoidance beliefs and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain conditions. J Orthop Sports Phys Ther. 2011;41:249–259.
    1. Klaber Moffett JA, Carr J, Howarth E. High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine (Phila Pa 1976) 2004;29:1167–72.
    1. da Costa BR, Vieira ER. Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med. 2010;53:285–323.
    1. Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015;29:405–423.
    1. Roddy E, Ogollah RO, Oppong R, Zwierska I, Datta P, Hall A, et al. Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. Br J Sports Med. 2021;55:262–271.
    1. Granviken F, Vasseljen O. Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trial. J Physiother. 2015;61:135–141.
    1. Santello G, Rossi DM, Martins J, Libardoni TC, de Oliveira AS. Effects on shoulder pain and disability of teaching patients with shoulder pain a home-based exercise program: a randomized controlled trial. Clin Rehabil. 2020;34:1245–1255.

Source: PubMed

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