45 Pain during shoulder exercises for patients with rotator cuff tendinopathy

Introduction Exercise therapy is an effective intervention for patients with rotator cuff (RC) tendinopathy, but there are no prospective randomized controlled trials addressing pain as an intervention variable. The aim was to examine the effect of allowing pain (PAllow) versus avoiding pain (PAvoid) during shoulder exercises for patients with symptomatic chronic RC tendinopathy.Materials and Methods In a prospective, assessor-blinded, pragmatic, randomized, controlled superiority trial, we included adults aged 18–55 with >3 months of symptoms and ultrasound-confirmed RC tendinopathy. Participants were recruited from the sports medicine and occupational medicine clinics at BFH. Both groups received a 26-week intervention with 8 physiotherapy sessions and home exercises. Pain was allowed in PAllow (up to 5 on Numeric Pain Rating Scale (NPRS)) or avoided in PAvoid (NPRS below 2) during exercises. Data were analysed with linear regression.Results A total of 84 participants (mean age 36 years, 45% women) were included. Average symptom duration was 26 months. Both groups improved significantly over time, with no difference at 26 weeks. At 1-year follow-up, PAllow showed a significantly greater improvement in SPADI. The PAllow improvement exceeded the minimal clinically important difference at both 26 weeks (11.2 points) and 1-year (16.2 points).Conclusion Performing shoulder exercises improved pain and function significantly over time in both groups. There was no difference between the groups at 26 weeks, but at 1-year follow-up, PAllow showed a significantly greater improvement in SPADI. We can safely allow patients with RC tendinopathy to complete shoulder exercises with moderate pain.