EXERCISE THERAPY FOR SHOULDER PAIN AIMED AT RESTORING NEUROMUSCULAR CONTROL: A RANDOMIZED COMPARATIVE CLINICAL TRIAL
Karen A. Ginn A1 and Milton L. Cohen A2
A1 Faculty of Health Sciences University of Sydney
A2 Faculty of Medicine University of New South Wales Australia
Objective: To compare the effectiveness of exercise therapy aimed at restoring neuromuscular control mechanisms at the shoulder with other conservative interventions for the treatment of chronic shoulder pain with and without accompanying stiffness. Design: Randomized control trial. Patients: A total of 138 volunteers with unilateral shoulder pain of local mechanical origin. Methods: Subjects were randomly allocated to receive exercise therapy aimed at restoring dynamic stabilizing mechanisms and muscle co-ordination at the shoulder; or subacromial corticosteroid injection; or a combination of physical modalities and range of motion exercises. Outcome measurements of pain intensity, functional impairment, active range of motion, isometric muscle force and self-assessed improvement were taken at baseline and after 5 weeks of treatment. Results: The mean/median changes in all outcome measurements at 5 weeks indicated that subjects in each treatment group, improved significantly with no difference between the treatment groups. Comparison with an earlier no-treatment trial would suggest that this improvement is greater than that which could be expected by natural recovery. Conclusion: Exercise therapy aimed at restoring neuromuscular control, corticosteroid injection and multiple physical modalities and range of motion exercises are equally effective in the short-term treatment of shoulder pain, with exercise therapy and corticosteroid injection being less costly to administer.