The effect of exercise therapy and Extracorporeal Shockwave Therapy on overhead athletes with subacromial pain syndrome

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The effect of exercise therapy and Extracorporeal Shockwave Therapy on overhead athletes with subacromial pain syndrome

 

Author: Tsui, Sin Mei Sammi
Title: The effect of exercise therapy and Extracorporeal Shockwave Therapy on overhead athletes with subacromial pain syndrome
Degree: Ph.D.
Year: 2016
Subject: Shoulder -- Wounds and injuries -- Exercise therapy.
Shoulder joint -- Wounds and injuries -- Exercise therapy.
Shoulder -- Wounds and injuries -- Physical therapy.
Shoulder joint -- Wounds and injuries -- Physical therapy.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: 221 pages : color illustrations
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2925547
URI: http://theses.lib.polyu.edu.hk/handle/200/8704
Abstract: Subacromial pain syndrome (SAPS) or rotator cuff tendinopathy is the most common cause of shoulder pain in overhead athletes. Therefore, it is important to understand the underlying mechanism so as the postulate the best rehabilitation for this population. Reduced subacromial space (extrinsic factor) and vascularity increase (intrinsic factor) were the common proposed factors for the cause of pain in SAPS. This project consisted of 5 inter-related studies. The first study (Chapter 2) aimed at assessing the association between subacromial space and intensity of pain, Study 2 (Chapter 3) was to detect presence and intensity of vascularity in supraspinatus tendon; and to evaluate relationships between tendon vascularity and resting subacromial space in overhead athletes with SAPS. In Studies 3 to 5, the effects of conventional exercise, Extracorporeal Shockwave Therapy and Bodyblade® training on pain reduction and functional improvement (using Disability Arm Shoulder Hand (DASH) Questionnaire) were compared. The inter-relationship among changes on pain intensity, subacromial space and tendon vascularity were then assessed at post-(Chapter 4), 3-month post-(Chapter 5) and 1 year post-intervention (Chapter 6). Study 1 confirmed the relationship between subacromial space and provoked pain in overhead athletes with SAPS. Greater intensity of provoked pain was associated with reduced subacromial space in male but widened subacromial space in female. In study 2, majority (>80%) of the overhead athletes with SAPS had mild to severe pathological changes in the supraspinatus tendon. More than 80% of the tendinopathic tendon had vascularization. Hypervascularity was associated with reduced subacromial space in male athletes. Findings from Studies 1 and 2 highlighted pain, subacromial space and vascularity in tendon were highly interrelated. Findings from Study 3 indicated that immediately after 8-weeks of conventional exercise or Extracorporeal Shockwave Therapy, the intensity of pain was reduced by a clinically significant level in the conventional exercise and Extracorporeal Shockwave Therapy groups, but not Bodyblade® group, and yet the improvement in the DASH scores exceeded minimal clinically detectable difference in conventional exercise and Bodyblade® groups but not Extracorporeal Shockwave Therapy group. Spearman correlation tests indicated that in male athletes receiving either conventional exercise or Bodyblade® training, percentage increase in subacromial space was correlated with percentage reduction in vascular index (rho=-0.63; p=0.037). The finding suggested that conventional exercise showed satisfactory clinical improvement in both pain and functional level. Exercise-induced modulation of extrinsic (widening of subacromial space) and intrinsic (decrease in vascularity) factors of SAPS are related.
Study 4 evaluated the interim effects of the interventions found in Study 3. The decrease in DASH score was significantly higher in the conventional exercise group (52.4±28.4%) when compared with Extracorporeal Shockwave Therapy (36.6±34.4%; p=0.013) and Bodyblade® groups (23.8±46.8%; p=0.037). Number of participants being successfully treated was significantly higher in the conventional exercise group (70%) when compared with Extracorporeal Shockwave Therapy (20%; p=0.012). In the male participants, the percentage of reduction in pain was related to the percentage increase in subacromial space in the exercise group (conventional exercise and Bodyblade®) (rho=0.74; p=0.006) but to the percentage decrease in vascularity index in the Extracorporeal Shockwave Therapy group (rho=-1.00; p=0.000). The findings suggested exercise and Extracorporeal Shockwave Therapy modulate pain by different mechanism, and combined therapy may further benefit the athletes. The result of Study 5 showed the conventional exercise group had significantly greater reduction in DASH score (63.7±26.1%) when compared with Extracorporeal Shockwave Therapy (37.5±43.7%; p=0.019) and Bodyblade® training group (35.2±45.9%; p=0.048). The study also showed highest successful rate in the conventional exercise group (60%) when compared with the extracorporeal shockwave therapy (33.3%) and Bodyblade® training (38.5%) group, despite the differences being statistically insignificant. Being male and in the conventional exercise group, the percentage improvement in DASH was correlated with Body Mass Index (rho=-0.94; p=0.005) and pre-intervention vascularity (rho=0.94; p=0.005). No subjects with moderate to severe supraspinatus tendon could be successfully treated with conventional intervention. These information help us to better screen overhead athletes with SAPS at the start of the conservative intervention.

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