Heavy shoulder strengthening exercise in people with hypermobility spectrum disorder (HSD) and long-lasting shoulder symptoms: a feasibility study

Behnam Liaghat, Søren T Skou, Uffe Jørgensen, Jens Sondergaard, Karen Søgaard, Birgit Juul-Kristensen, Behnam Liaghat, Søren T Skou, Uffe Jørgensen, Jens Sondergaard, Karen Søgaard, Birgit Juul-Kristensen

Abstract

Background: People with hypermobility spectrum disorder (HSD) are in great risk of experiencing shoulder symptoms, but evidence for treatment is sparse. Therefore, the objective was to evaluate the feasibility of 16-week shoulder strengthening programme for improving shoulder strength and function in people with HSD and shoulder symptoms for more than 3 months to inform a future randomised controlled trial (RCT).

Methods: Twelve participants (11 females, 39.3 ± 13.9 years) with HSD and shoulder instability and/or pain for more than 3 months underwent a 16-week heavy shoulder strengthening exercise programme three times weekly using exercises targeting scapular and rotator cuff muscles. Primary outcomes were pre-defined research progression criteria including recruitment rate (acceptable, 6 participants/month), assessment duration (acceptable: < 120 min), participant retention (acceptable: > 80% complete intervention), training adherence (acceptable: > 75% adhere to > 36 training sessions) and adverse events (acceptable: minor events with no participants discontinuing the study), besides participant and physiotherapist feedback. Secondary treatment outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI, 0-2100 better to worse), self-reported pain, kinesiophobia and fatigue, isometric shoulder strength, besides clinical tests for instability, hypermobility, laxity, and proprioception.

Results: Recruitment rate was 5.6/month, assessment duration (mean ± SD) 105 ± 9 min, retention 100%, adherence 83%, and four participants experienced short-lasting soreness or pain. Participant feedback was positive, and physiotherapists found the intervention relevant and applicable to the population. The WOSI total score showed an improvement by 51% (mean ± SD, points: baseline 1037 ± 215; Follow up 509 ± 365; mean change (95% CI), - 528 (- 738, - 318)), and participants reported reduced pain, kinesiophobia and fatigue. Shoulder strength measurements improved by 28-31% (mean change (95% CI), Nm/kg: scaption 0.51 (0.23, 0.78); internal rotation 1.32 (0.70, 1.95) and external rotation 0.89 (0.37, 1.40)), and clinical tests indicated decreased shoulder laxity/instability.

Conclusions: The shoulder strengthening exercise programme was feasible and safe for people with HSD and long-lasting shoulder symptoms. A future RCT, with an improved recruitment strategy, will demonstrate whether the exercise programme is also effective in improving symptoms and muscle-tendon function in this population.

Trial registration: ClinicalTrials.gov: NCT03547570. Registered on May 3, 2018.

Keywords: Hypermobility; Hypermobility spectrum disorder; Shoulder; Strength; WOSI.

Conflict of interest statement

Competing interestsSTS reports personal fees from the Journal of Orthopaedic & Sports Physical Therapy, grants from The Lundbeck Foundation, personal fees from Munksgaard, outside the submitted work; and being a co-founder of GLA:D. GLA:D is a non-profit initiative hosted at the University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. JS reports grants from Astra-zeneca, outside the submitted work. BL, UJ, KS and BJK have nothing to disclose.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
The exercise programme included five exercises targeting scapular and rotator cuff muscles. A1-A2: sidelying external rotation (ER) in neutral, B1-B2: prone horizontal abduction, C1-C2: prone ER in 90° of shoulder abduction, D1-D2: supine scapular protraction, and E1-E2: seated shoulder elevation in the scapular plane
Fig. 2
Fig. 2
Flow diagram of participant enrolment, allocation, follow up and analysis
Fig. 3
Fig. 3
The Western Ontario Shoulder Instability Index (WOSI) total score for every participant from baseline to follow up after 16 weeks of heavy shoulder strengthening exercise programme

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