title: Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial.
abstract: OBJECTIVE
  To investigate superior value of adding heavy load eccentric training to conservative treatment in patients with subacromial impingement.
  
  
  METHODS
  Sixty-one patients with subacromial impingement were included and randomly allocated to the traditional rotator cuff training (TT) group (n = 30, mean age = 39.4 ± 13.1 years) or traditional rotator training combined with heavy load eccentric training (TT + ET) group (n = 31, mean age = 40.2 ± 12.9 years). Isometric strength was measured to abduction at 0°, 45° and 90° of scapular abduction and to internal and external rotation. The SPADI questionnaire was used to measure shoulder pain and function. Patients rated subjective perception of improvement. Outcome was assessed at baseline, at 6 and 12 weeks after start of the intervention. Both groups received 9 physiotherapy treatments over 12 weeks. At home, the TT group performed traditional rotator cuff strengthening exercises 1x/day. The TT + ET group performed the same exercises 1x/day and a heavy load eccentric exercise 2x/day.
  
  
  RESULTS
  After treatment, isometric strength had significantly increased in all directions, and SPADI score had significantly decreased. The TT + ET group showed a 15% higher gain in abduction strength at 90° of scapular abduction. Chi-square tests showed patients' self-rated perception of improvement was similar in both groups.
  
  
  CONCLUSIONS
  Adding heavy load eccentric training resulted in a higher gain in isometric strength at 90° of scapular abduction, but was not superior for decreasing pain and improving shoulder function. This study showed that the combination of a limited amount of physiotherapy sessions combined with a daily home exercise programme is highly effective in patients with impingement.
  
  
  METHODS
  II.
authors.affiliation: Department of Physiotherapy and Rehabilitation Sciences, Ghent University, Campus Heymans, 3B3, De Pintelaan 185, 9000, Ghent, Belgium. annelies.maenhout@ugent.be
authors.forename: Annelies G
authors.initials: AG
authors.lastname: Maenhout
authors.forename: Nele N
authors.initials: NN
authors.lastname: Mahieu
authors.forename: Martine
authors.initials: M
authors.lastname: De Muynck
authors.forename: Lieven F
authors.initials: LF
authors.lastname: De Wilde
authors.forename: Ann M
authors.initials: AM
authors.lastname: Cools
mesh_terms: D000328:Adult; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D055070:Resistance Training; D019534:Shoulder Impingement Syndrome / Q000534:rehabilitation*