ECCENTRIC EXERCISE VERSUS CLOSED CHAIN EXERCISE FOR PAIN AND RANGE OF MOTION IN ROTATOR CUFF TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Abstract

Rotator cuff tendinopathy is a leading cause of shoulder pain and disability, and loaded exercise is the accepted first-line conservative treatment; which loading mode is preferable remains unsettled. Eccentric loading is well supported for lower limb tendinopathy, whereas closed kinetic chain loading is favoured for the joint stability it confers through reduced shear. This randomized controlled trial compared the two in patients with rotator cuff tendinopathy. Thirty adults aged 18 to 45 years with unilateral, clinically diagnosed rotator cuff tendinopathy were recruited from the physiotherapy outpatient department of a tertiary teaching hospital in Puducherry, India, and allocated by simple randomization to eccentric exercise (Group A, n = 15) or closed chain exercise (Group B, n = 15). Both groups also performed pectoralis minor and cross-body adduction stretches. Training was carried out on three alternate days each week for 12 weeks. Pain was measured with a visual analogue scale and active shoulder flexion, abduction, internal rotation and external rotation with a universal goniometer, at baseline and at 12 weeks. Both groups improved significantly on every outcome. Improvement was greater after eccentric exercise for pain, with a between-group difference in change of 1.13 points, and for flexion, abduction, internal rotation and external rotation, with between-group differences in change of 20.7, 30.0, 7.3 and 16.3 degrees respectively; all comparisons remained significant after correction for multiple testing, and analysis of covariance adjusting for baseline values reproduced the same pattern. Post-test scores alone did not separate the groups, and the between-group pain difference is close to the accepted minimal clinically important difference. Eccentric loading produced larger short-term gains than closed chain loading, but the trial was small, unblinded and unregistered, and the effect sizes should be regarded as provisional pending replication in adequately powered, blinded trials that also measure shoulder function.