Schulz R1,2, Prill R1, Kirschner J1, Zirr M3, Michel S1
1Brandenburg University of Technology Cottbus - Senftenberg, Therapy Science II, Senftenberg, Germany, 2University of Potsdam, Department of Sport and Health Sciences, Potsdam, Germany, 3German Sport University Cologne, Cologne, Germany
Background: Rotator cuff tendinopathies are one of the most prevalent diseases located at the shoulder joint. Whereas research on tendinopathies of the achilles- and patellar tendon shows fairly good results for eccentric training as the treatment of choice on the highest levels of evidence, comparable evidence for the same treatment approach for rotator cuff tendinopathies is missing. As it was already shown in achilles tendons that eccentric training can positively influence some pathomechanisms of tendinopathy, it is likely that this could be true in rotator cuff tendons too.
Purpose: This systematic review aims to clarify whether or not eccentric training is beneficial for patients with rotator cuff tendinopathy.
Methods: The electronic databases MEDLINE and Cochrane Central Register for Controlled Trials (CENTRAL) as well as the citation database Web of Science Core Collection (WOSCC) were searched for relevant articles during August 2018. The main search string consisted of synonyms of the search terms "eccentric training", "tendinopathy" and "rotator cuff".
The inclusion critera were:
(1) controlled study design with one group performing eccentric exercises while the control group received a different kind of treatment
(2) participants of the studies had to be diagnosed with rotator cuff tendinopathy
(3) the studies had to use at least one outcome measurement in the categories of pain, function or strength
All included studies were assessed for their methodological quality (PEDro) and their risk of bias (ROB2.0). Furthermore, this systematic review was conducted in accordance to the PRISMA reporting guidelines and the results were classified after levels of evidence.
Results: 218 articles were screened as the result of the database search. After exclusion of 213 studies, five studies were eligble for analysis in this systematic review.
The assessment of these studies with the PEDro-scale, four of them appeared to be of low quality ( 6 points), while one study showed high quality (>6 points).
Overall, the included studies obtain a high risk of bias.
Regarding improvements in the categories of pain and function, there is conflicting evidence. However, epecially regarding measurements of function, there are some indices for favourable results due to eccentric training regimes. In terms of parameters of strength, there is moderate evidence for better outcomes due to the use of eccentric training compared to concentric training or standard physiotherpeutic treatment.
The used exercise protocols for eccentric training are highly variable, but most of the ones used in these studies were of low load and were designed as home exercise protocols.
Conclusion(s): Dependable data are missing to draw any final conclusions about treatment effects of eccentric training for tendinopathies of the rotator cuff. There are some indices for positive effects due to eccentric training in these kind of patients.
Implications: There is a strong need for well-designed studies investigating treatment effects for tendinopathies of the rotator cuff.
Moreover, if eccentric training will be investigated any further as a treatment option for rotator cuff tendinopathy, the exercise protocols have to become more comparable.
Keywords: eccentric, 'rotator cuff', tendinopathy
Funding acknowledgements: The authors received no specific funding for this work.
Purpose: This systematic review aims to clarify whether or not eccentric training is beneficial for patients with rotator cuff tendinopathy.
Methods: The electronic databases MEDLINE and Cochrane Central Register for Controlled Trials (CENTRAL) as well as the citation database Web of Science Core Collection (WOSCC) were searched for relevant articles during August 2018. The main search string consisted of synonyms of the search terms "eccentric training", "tendinopathy" and "rotator cuff".
The inclusion critera were:
(1) controlled study design with one group performing eccentric exercises while the control group received a different kind of treatment
(2) participants of the studies had to be diagnosed with rotator cuff tendinopathy
(3) the studies had to use at least one outcome measurement in the categories of pain, function or strength
All included studies were assessed for their methodological quality (PEDro) and their risk of bias (ROB2.0). Furthermore, this systematic review was conducted in accordance to the PRISMA reporting guidelines and the results were classified after levels of evidence.
Results: 218 articles were screened as the result of the database search. After exclusion of 213 studies, five studies were eligble for analysis in this systematic review.
The assessment of these studies with the PEDro-scale, four of them appeared to be of low quality ( 6 points), while one study showed high quality (>6 points).
Overall, the included studies obtain a high risk of bias.
Regarding improvements in the categories of pain and function, there is conflicting evidence. However, epecially regarding measurements of function, there are some indices for favourable results due to eccentric training regimes. In terms of parameters of strength, there is moderate evidence for better outcomes due to the use of eccentric training compared to concentric training or standard physiotherpeutic treatment.
The used exercise protocols for eccentric training are highly variable, but most of the ones used in these studies were of low load and were designed as home exercise protocols.
Conclusion(s): Dependable data are missing to draw any final conclusions about treatment effects of eccentric training for tendinopathies of the rotator cuff. There are some indices for positive effects due to eccentric training in these kind of patients.
Implications: There is a strong need for well-designed studies investigating treatment effects for tendinopathies of the rotator cuff.
Moreover, if eccentric training will be investigated any further as a treatment option for rotator cuff tendinopathy, the exercise protocols have to become more comparable.
Keywords: eccentric, 'rotator cuff', tendinopathy
Funding acknowledgements: The authors received no specific funding for this work.
Topic: Musculoskeletal: upper limb; Orthopaedics; Research methodology & knowledge translation
Ethics approval required: No
Institution: Brandenburg University of Technology
Ethics committee: N/A
Reason not required: As it is a systematic review, it does not involve any human beings or animals
All authors, affiliations and abstracts have been published as submitted.
