The Addition of Exercise to High-Intensity Laser Therapy Improves Treatment Effectiveness on Pain and Muscle Strength in Patients with Subacromial Pain Syndrome: A Randomized Trial

Abstract

Objective To assess the efficacy of adding exercise to high-intensity laser therapy (HILT) in improving treatment effectiveness for clinical outcomes in patients with subacromial pain syndrome.

Methods Thirty patients with subacromial pain syndrome were randomly assigned to the HILT-only group (n=15) or HILT&Exercise group (n=15). The primary outcome was shoulder function and disability. Secondary outcomes were pain, range of motion, proprioception (joint position sense), and muscle strength.

Results Shoulder function and disability, pain, range of motion, joint position sense, and some muscle strength improved in both groups (p<0.05). There was no significant time-group interaction for the Constant-Murley Score, Shoulder Pain and Disability Index, rest pain, range of motion, and joint position sense (p>0.05). Time-group showed significant effects for activity pain and strength in favor of the HILT&Exercise group. Middle trapezius, lower trapezius, and supraspinatus strength increased after HILT plus exercise (p<0.05), activity pain, upper trapezius, serratus anterior, and subscapularis strength improved more compared to HILT (p<0.05).

Conclusions We found no clinically important differences between HILT and HILT-plus exercise in shoulder function and disability, rest pain, mobility, and proprioception, in patients with subacromial pain syndrome. The addition of exercise to HILT was superior to HILT for improving activity pain and muscle strength.

Zusammenfassung

Ziel Bewertung der Wirksamkeit des Hinzufügens von Bewegung zur hochintensiven Lasertherapie (HILT) zur Verbesserung der Behandlungswirksamkeit für klinische Ergebnisse bei Patienten mit subakromialem Schmerzsyndrom.

Methoden Dreißig Patienten mit subakromialem Schmerzsyndrom wurden randomisiert in die HILT-Gruppe (n=15) oder der HILT&Übung-Gruppe (n=15) zugeteilt. Die primären Messpunkte warren Schulterfunktion und Behinderung. Sekundäre Messpunkte waren Schmerzen, Bewegungsumfang, Propriozeption (Gelenkpositionsgefühl) und Muskelkraft.

Ergebnisse Schulterfunktion und -behinderung, Schmerzen, Bewegungsumfang, Gelenkpositionsgefühl und Muskelkraft verbesserten sich in beiden Gruppen (p<0,05). Es gab keine signifikante Zeitgruppeninteraktion für Constant-Murley Score, Shoulder Pain and Disability Index, Ruheschmerz, Bewegungsumfang und Gelenkpositionsgefühl (p>0,05). Die Zeitgruppe zeigte signifikante Effekte bei Aktivitätsschmerz und Kraft zugunsten der HILT&Übung-Gruppe. Die Kraft des mittleren Trapezmuskels, des unteren Trapezmuskels und des Supraspinatus nahm nach HILT plus Übung zu (p<0,05), Aktivitätsschmerz, die Kraft des oberen Trapezmuskels, des vorderen Serratus und des M. subscapularis verbesserte sich stärker im Vergleich zu HILT (p<0,05).

Schlussfolgerungen Wir fanden keine klinisch bedeutsamen Unterschiede zwischen HILT- und HILT-plus-Übungen bei Schulterfunktion und -behinderung, Ruheschmerz, Mobilität und Propriozeption bei Patienten mit subakromialem Schmerzsyndrom. Das Hinzufügen von Bewegung zu HILT war bei der Verbesserung von Aktivitätsschmerzen und Muskelkraft gegenüber HILT überlegen.

Keywords

Shoulder pain - shoulder impingement syndrome - physical therapy - phototherapy - light therapy

Schlüsselwörter

Schulterschmerzen - Schulter-Impingement-Syndrom - physikalische Therapie - Phototherapie - Lichttherapie

• References

• 1 Faber E, Kuiper JI, Burdorf A. et al. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil 2006; 16: 7-25
• 2 Anderson VB, Wee E. Impaired Joint Proprioception at Higher Shoulder Elevations in Chronic Rotator Cuff Pathology. Arch Phys Med Rehab 2011; 92: 1146-1151
• 3 Pieters L, Lewis J, Kuppens K. et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther 2020; 50: 131-141
• 4 Santamato A, Solfrizzi V, Panza F. et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther 2009; 89: 643-652
• 5 Ezzati K, Laakso EL, Salari A. et al. The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review. J Lasers Med Sci 2020; 11: 81-90
• 6 Best N, Derlien S, Smolenski UC. High Level Laser Therapy at Patients with Musculoskeletal Disorders. A Treatment with 120 Patients. Phys Med Rehab Kuror 2010; 20: 262-265
• 7 Ren KX, Ren CJ, Li LL. et al. Efficacy of Laser Therapy in the Treatment of Shoulder Impingement Syndrome: A Systematic Review and Meta-Analysis. Phys Med Rehab Kuror 2022; 32: 347-356
• 8 Best N, Loppar A, Derlien S. et al. The Effectiveness of Ultrasound Applications in Comparison to High-intensity Laser Regarding to the Outcome Measure of Pain Intensity at Patients with Disorders of the Lumbar Spine or the Shoulder. Phys Med Rehab Kuror 2012; 22: 154-161
• 9 Best N, Loppar A, Derlien S. et al. Comparison of the Therapy Combinations: Laser Therapy with Manual Therapy Compared to Ultrasound with Manual Therapy at Patients with Disorders of the Lumbar Spine or the Shoulder. Phys Med Rehab Kuror 2015; 25: 254-259
• 10 Pekyavas NO, Baltaci G. Short-term effects of high-intensity laser therapy, manual therapy, and Kinesio taping in patients with subacromial impingement syndrome. Lasers Med Sci 2016; 31: 1133-1141
• 11 Aceituno-Gomez J, Avendano-Coy J, Gomez-Soriano J. et al. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil 2019; 33: 894-903
• 12 Elsodany AM, Alayat MSM, Ali MME. et al. Long-Term Effect of Pulsed Nd:YAG Laser in the Treatment of Patients with Rotator Cuff Tendinopathy: A Randomized Controlled Trial. Photomed Laser Surg 2018; 36: 506-513
• 13 Michener LA, Walsworth MK, Doukas WC. et al. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil 2009; 90: 1898-1903
• 14 Steuri R, Sattelmayer M, Elsig S. et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017; 51: 1340-1347
• 15 Celik D. Turkish version of the modified Constant-Murley score and standardized test protocol: reliability and validity. Acta Orthop Traumato 2016; 50: 69-75
• 16 Bumin G, Tuzun EH, Tonga E. The Shoulder Pain and Disability Index (SPADI): Cross-cultural adaptation, reliability, and validity of the Turkish version. J Back Musculoskelet 2008; 21: 57-62
• 17 Clark P, Lavielle P, Martinez H. Learning from pain scales: Patient perspective. J Rheumatol 2003; 30: 1584-1588
• 18 Riddle DL, Rothstein JM, Lamb RL. Goniometric Reliability in a Clinical Setting - Shoulder Measurements. Phys Ther 1987; 67: 668-673
• 19 Kolber MJ, Fuller C, Marshall J. et al. The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer. Physiother Theory Pract 2012; 28: 161-168
• 20 Michener LA, Boardman ND, Pidcoe PE. et al. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther 2005; 85: 1128-1138
• 21 Turner N, Ferguson K, Mobley BW. et al. Establishing Normative Data on Scapulothoracic Musculature Using Handheld Dynamometry. J Sport Rehabil 2009; 18: 502-520
• 22 Haik MN, Camargo PR, Zanca GG. et al. Joint position sense is not altered during shoulder medial and lateral rotations in female assembly line workers with shoulder impingement syndrome. Physiother Theor Pr 2013; 29: 41-50
• 23 Paul A, Lewis M, Shadforth MF. et al. A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis 2004; 63: 1293-1299
• 24 Kukkonen J, Kauko T, Vahlberg T. et al. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 2013; 22: 1650-1655
• 25 Dworkin RH, Turk DC, Wyrwich KW. et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008; 9: 105-121
• 26 Kim KH, Kim DH. The Effects of Kinesio Taping with LASER Therapy to Improve on Pain Threshold, Blood Flow, and Balance Ability in Patient with Knee Osteoarthritis. Phys Med Rehab Kuror 2022; 54: 19-26
• 27 Lund JP, Donga R, Widmer CG. et al. The Pain-Adaptation Model - a Discussion of the Relationship between Chronic Musculoskeletal Pain and Motor-Activity. Can J Physiol Pharm 1991; 69: 683-694
• 28 Ager AL, Borms D, Deschepper L. et al. Proprioception: How is it affected by shoulder pain? A systematic review. J Hand Ther 2020; 33: 507-516
• 29 Ager AL, Borms D, Bernaert M. et al. Can a Conservative Rehabilitation Strategy Improve Shoulder Proprioception? A Systematic Review. J Sport Rehabil 2020; 30: 136-151
• 30 Ashton-Miller JA, Wojtys EM, Huston LJ. et al. Can proprioception really be improved by exercises?. Knee Surg Sports Traumatol Arthrosc 2001; 9: 128-136
• 31 Struyf F, Lluch E, Falla D. et al. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders. Eur J Appl Physiol 2015; 115: 225-234
• 32 Folland JP, Williams AG. The adaptations to strength training : morphological and neurological contributions to increased strength. Sports Med 2007; 37: 145-168
• 33 Hakkinen K, Kallinen M, Izquierdo M. et al. Changes in agonist-antagonist EMG, muscle CSA, and force during strength training in middle-aged and older people. J Appl Physiol (1985) 1998; 84: 1341-1349
• 34 Ellis H, Mahadevan V. Clinical anatomy: applied anatomy for students and junior doctors. 14th. Aufl. Chichester, West Sussex: John Wiley & Sons; 2019
• 35 Kibler WB, Ludewig PM, McClure PW. et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med 2013; 47: 877-885