Extremities: Trials

 

Beyer R, Kongsgaard M, Kjær B, Øhlenschlæger T, Kjær M, Magnusson P, Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial, Am J Sports Med, 431,704, 2014

This RCT with 58 patients with Achilles tendinopathy compared a 12 week intervention of eccentric exercises to a heavy slow resistance protocol. Outcomes on VISA-A and structural changes showed the same improvement with both groups both in short and long term (1 year)

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Bjornsson Hallgren H, Holmgren T, Oberg B, Johansson K, Adolfsson L, A specific exercise strategy reduced the need for surgery in subacromial pain patients, Br J Sports Med, 48:1431-1436, 2014

97 patients on the waiting list for subacromial decompression were randomised into a loaded predominantly eccentric exercise group or a general exercise group. Those in the specific exercise group had significantly reduced need for surgery at 1 year

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Brox JI, Gjengedal E, Uppheim G et al, Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomised, controlled study in 125 patients with a 2 ½ -y, J Shoulder Elbow Surg, 8:102-111, 1999

RCT of loading exercises versus surgery versus placebo for chronic rotator cuff problems (contractile dysfunction) with long-term follow up. Both short and long-term exercise and surgery groups had significantly better outcomes than control group, with no differences between them.

 

Heidar Abady A, Rosedale R, Chesworth BM, Rotondi MA, Overend TJ, Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study , J Man Manip Ther, 25, 5, 235-243, 2017

The was the first study to investigate the clinical application of MDT on a cohort of shoulder patients. Pain and functional outcomes were taken at 2 and 4 weeks. 29% of the patients had a cervical Derangement as a cause of their shoulder pain and 38% had a shoulder Derangement. So 2/3s of patients had a rapid response to treatment and an early discharge. The patients with shoulder Dysfunction had a slower response as would be predicted. MDT classification aligned with the outcomes and demonstrated some preliminary validity for MDT use in the shoulder.

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Holmgren T, Hallgren HB, Oberg B, Adolfsson L, Johansson K., Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study, Br Med J, 344:e787, 2012

102 patients with at least 6 months shoulder pain with several signs of impingement, who had failed previous conservative care and were referred for surgery, were randomised to either eccentric strengthening exercises for the rotator cuff, concentric scapula exercises and mobilisation or non-specific neck shoulder exercises. Patients who received the specific strengthening exercises had significantly better outcomes in terms of pain and function, and were significantly less likely to undergo surgery.