Effectiveness of medical exercise therapy in patients with long lasting unilateral shoulder pain: a randomized controlled trial with one year follow-up.

INTERVENTION: Medical exercise therapy: Type of exercises completed: shoulder range of motion exercises. High repetition group. Eight shoulder range of motion exercises were completed each treatment session, with three sets of 30 repetitions for each exercise. The approximate duration of each treatment session was one hour. Low repetition group. Five shoulder range of motion exercises were completed each treatment session, with three sets of 30 repetitions for each exercise. The approximate duration of each treatment session was thirty minutes. For both groups, patient history, symptoms, and clinical findings were the basis for choosing starting positions, range of motion, and weight resistance for the patient being able to do three sets of 30 repetitions. Each exercise was tested using a specific clinical test procedure developed in medical exercise therapy (Torstensen 1999, Torstensen 2004). Thus, each patient had an individual tailored exercise program. The patient exercised within the comfortable range of motion with normal humeroscapular rhythm, and in the early phase the weight from the pulley apparatus was used to deload some of the weight of the arm, making it possible to perform the high number of repetitions in sets (three sets of 30 repetitions) with good kinetic control. As the patient improved, experiencing less pain, the range of motion and weight resistance were increased and the starting position was changed according to the progression ladder developed in medical exercise therapy (Torstensen 1999). The number of repetitions and sets was kept constant for both intervention groups during the treatment period, which involved three treatments a week for 12 weeks. The effect of the program is a combination of the global aerobic exercises using a stationary bike, treadmill, or step machine, and the semiglobal and local exercises using such medical exercise therapy equipment, as a wall pulley apparatus, lateral pulley apparatus, incline board, angle bench, multiple purpose bench, shoulder rotator, dumbbells or barbells. CONDITION: Shoulder subacromial impingement PRIMARY OUTCOME: Shoulder pain assessed by mean visual analogue scale score SECONDARY OUTCOME: Mean function score, assesed by isometric strength test and active range of motion test. INCLUSION CRITERIA: positive subacromial impingement test