#001-Rotator Cuff Tendinopathy, Lumbopelvic Pain, Knee OA and Scoliosis
Covering
Which is better for rotator cuff tendinopathy, high or low dose of exercise?
Protocol for electrical stimulation to improve pain and strength for Knee OA patients!
Pelvic floor muscle training to treat lumbopelvic pain in women?
The Effectiveness of Scoliosis specific exercise for Adolescent idiopathic scoliosis?
Estimated reading time: 5 minutes, 5 seconds.
Articles
Which is better for rotator cuff tendinopathy, high or low dose of exercise?
This systematic review, included 3 trials (283 Participant), 2 used high vs low dose for 12 weeks and 1 for 6 weeks, in one trial all exercise sessions were supervised and the other 2 had supervised and home-based exercise.
Exercises used: Progressive and resisted exercise for abduction 90 degree and internal and external rotation, eccentric rotator cuff exercises, scapular exercises, posterior shoulder stretching and exercise loading all muscles acting on the shoulder, shoulder girdle and entire upper extremity.
High Dose: 3 Sets/10 to 30 repetitions, 2 times/day (2 trials) or 3 sessions/week (1 trial), Duration 6,8 and 12 weeks. Load progression based on pain and fatigue. allowed pain: if it subsides within 1 hour, less than 5/10 VAS or minimal pain. Exercise progression to dumbbells, therabands, pulley machine and barbells.
Low Dose: 1 to 2 sets/10 repetition, 2 times/day (2 trials) or 3 sessions/week (1 trial), Duration 6,8 and 12 weeks. No load or progression of exercise.
Results: As per many trials, the results indicated low to very low certainty that high dose exercise is superior to lower dose exercise to improve function in Rotator cuff tendinopathy.
Although this may seem like common knowledge, the progression of exercise dose can improve function but keep in mind that there is not enough evidence to support this, also, it is unclear if exercise can influence pain levels and for exercise to start showing any benefit, it should be maintained for at least for 12 weeks.
Protocol for electrical stimulation to improve pain and strength for Knee OA patients!
This guideline that is based on a systematic review of the literature sat out to answer this question: “What are the parameters of electrical stimulation intervention that improve muscle strength and decrease pain in adult patients with knee osteoarthritis?”
The Impact of quadriceps femoris weakness on joint stability:
Evidence has shown that Muscle weakness decreases joint stability, increases articular cartilage degeneration, subchondral bone hardening, number of intra-articular osteophytes, and synovium inflammation, therefore, weakness in quadriceps femoris increases intra-articular pressure, which contribute to the death of chondrocytes, destruction of cartilage matrix, and subchondral sclerosis.
Results: Sample: 9 articles/459 Participant.
- Neuromuscular electrical stimulation (NMES) is the most effective electrical stimulation method to improve function and decrease pain in patients with Knee OA.
- NMES effectiveness is improved when combined with a strengthening program.
Dose and Parameters:
- Frequency: at least 50 Hz and no more than 70 Hz
- Pulse Duration: 200 and 400 μs.
- Session Duration: 20 Minutes.
- Frequency: 3-5 Times per week.
- Did not specify for how many weeks!
Summery and Notes:
- Increasing quadriceps femoris is essential for patients with knee OA.
- NMES can be added to your treatment plan for patients with knee OA.
- The results provided by this systematic review did not indicate how long this effect can last after treatment.
- As you may know, using multiple treatment methods is usually the best to get better results, in this case, combining a strengthening program with NMES program (the one mentioned above) is better than using only one of them.
Pelvic floor muscle training to treat lumbopelvic pain in women?
More than half of pregnant woman experience lumbopelvic pain (LBP) during and even after pregnancy, one of the proposed treatments to manage LBP is Pelvic floor muscle training (PFNT) , this systematic review and meta-analysis goal was to investigate the effectiveness of PFNT to decrease pain and improve function in woman suffering from (LBP).
Data from 8 RCTs (469 Participant) showed the following:
- Pain in pregnant woman: Low certainty evidence that PFNT is more effective than minimal intervention (Basic education, body posture and ergonomic advices).
- Pain in non-pregnant woman: Very low certainty evidence that is PFNT with usual care is more effective than usual care alone.
- Disability in pregnant woman: Low certainty evidence that PFNT is more effective than minimal intervention at immediate term.
- Disability in non-pregnant woman: Very low certainty evidence that is PFNT with usual care is more effective than usual care alone.
PFNT dose and type:
- Frequency used in RCTs: 6 Times/day for 8 weeks, 2 times/week for 6 weeks, 3 times/week for 12 weeks, Daily for 4 months, 3 times/week for 6 weeks (2 trials), daily exercise at home and classes every 2 weeks during 10 weeks and 10 woman trained ≥ 1.5 times/day and 15 woman trained < 1.5 times/day.
- Type: Strength based PFNT.
The results of this trial failed to recommend PFNT for treating Lumbopelvic pain, at best, the very low certainty evidence suggest that it can be combined with other methods such as Pilates.
The Effectiveness of Scoliosis specific exercise for Adolescent idiopathic scoliosis?
Adolescent idiopathic scoliosis (AIS) is Lateral deviation, axial rotation, and abnormal sagittal curvature of the spine with unclear etiology.
3 Principles that any SSE adhere to:
- Three-dimensional self-correction.
- Training activities of daily living.
- Stabilization of corrected postures.
SSE Types (Mentioned in the article):
- Schroth Method.
- Scientific exercise approach to scoliosis (SEAS).
- Body Awareness exercise.
- Xinmiao approach.
Data from 10 studies, 8 RCTs and 2 CCTs (494 Participant):
- 5 Studies reported a significant decrease in cobb angle (5 degrees or more) in moderate scoliosis patients.
- 2 Studies suggested that SSE with bracing is superior to bracing alone.
- 1 Study suggested that SSE could not replace bracing to treat moderate scoliosis due to the lack of comparable effects between the two method.
- 2 Studies found that SSE had a significant effect on a curve regression for mild scoliosis.
- SSE was not superior to brace or other exercises in improving either ATR (angle of trunk rotation in degrees) or shoulder balance for brace-wearing patients.
- SSE was only effective for improving truncal asymmetry in patients with moderate scoliosis if used as a supplement to body awareness exercise.
- SSE can influence ATR when applied to mild scoliosis.
In conclusion:
- Limited evidence with moderate quality suggested that SSE can significantly reduce Cobb angle and improve truck asymmetry.
- The effect of SSE with brace wearing on treating moderate scoliosis is unclear.
- Insufficient evidence is available to implicate any effects of SSE on changes in QoL.
This such an interesting topic and the evidence behind it is very confusing, a detailed report (for physiokeys+) regarding the evidence behind different treatment methods for scoliosis is under writing.
Good Note
?Someone told us the parameters for a modality that is based on good evidence, YAY!
Bad Note
??♀️Thousands of studies and yet we still get very low to low certainty results. ??♀️
References
- The Efficacy of Higher Versus Lower Dose Exercise in Rotator Cuff Tendinopathy: A Systematic Review of Randomized Controlled Trials. (Restricted Access)
- New Guidelines for Electrical Stimulation Parameters in Adult Patients With Knee Osteoarthritis Based on a Systematic Review of the Current Literature. (Restricted Access)
- Pelvic floor muscle training for women with lumbopelvic pain: A systematic review and meta‐analysis. (Open Access)
- Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. (Open Access)