Can Exercise Help Relieve Shoulder Pain?

By Drs. Marc-Olivier Dubé, François Desmeules and Jean-Sébastien Roy

It is estimated that close to 70 per cent of the population will experience shoulder pain at some point in their lives.

This pain would not pose a problem if it disappeared as quickly as it appeared. Unfortunately, shoulder pain tends to persist over time. In half of patients, the pain lingers or reoccurs one year after its initial appearance. It can even persist for several years in some cases.

Approximately 70 per cent of shoulder pain episodes requiring consultation with a health-care provider can be identified as rotator cuff related shoulder pain. This refers to pain and loss of function in the shoulder, mainly during movements requiring the arm to be lifted. Although a number of effective options are available to patients, a third of them will not experience any significant improvement in their condition, regardless of the interventions used.

There are several possible reasons for this limited success. Exercise selection and some psychological and contextual characteristics specific to each individual have been identified as potential hypotheses.

As experts in the field of shoulder pain, we propose to shed light on the effectiveness of various interventions for the management of shoulder pain, and the role that some variables may play in the resolution of this pain.

Our research team therefore set out to find out:

1. Whether one type of exercise should be prioritized over another in the management of shoulder pain.

2. Whether the addition of exercises (the pet peeve of many people who consult a rehabilitation provider) lead to additional benefits compared with an intervention comprising only of education and advice to foster pain self-management.

3. Whether some psychological and contextual characteristics, such as participants’ expectations of the intervention effectiveness and pain self-efficacy, are associated with a better prognosis.

Pain self-efficacy is the level of confidence someone has in their ability to carry out their activities and achieve their goals despite pain.

What We Found

In our new study published in the British Journal of Sports Medicine, 123 people with shoulder pain lasting for more than three months were randomly assigned to one of three 12-week interventions:

1. Education

2. Education combined with motor control exercises

3. Education combined with strengthening exercises

Questionnaires were used to monitor changes in participants’ condition over time, particularly in terms of their pain and functional capacity.

Before the start of the intervention, we also used questionnaires to measure participants’ expectations of the effectiveness of the intervention they were about to receive, as well as their level of pain self-efficacy.

Education: Participants in this group received two sessions of education and advice with a physiotherapist. The information was about the shoulder and pain, and the advice included strategies for the self-management of their condition.

Participants were also told about the importance of being active and adopting a healthy lifestyle to optimize the management of persistent pain, including proper diet, hydration, stress management and sleep hygiene.

Finally, participants were asked to watch six short videos on these themes. Here’s one:

After viewing, they were asked to identify the aspects they felt were important and those that raised questions in order to discuss them with the physiotherapist.

Education combined with motor control exercises: Participants in this group completed a 12-week program that combined education with exercises.

The exercises included modifications in the way they performed their movements to enable them to move their arm with less pain. These modifications were integrated with exercises reproducing gestures involving the shoulder during daily activities.

Education combined with strengthening exercises: Participants in this group received the same education component, along with  a shoulder muscle strengthening program to be performed daily for 12 weeks.

At the end of the study, participants in all three groups showed improvements in pain and function. However, the addition of exercises (motor control or strengthening) to the education intervention did not lead to additional benefits.

People recruited into the study whose symptoms were considered resolved following the 12-week intervention had more positive expectations regarding the effectiveness of their intervention and had higher levels of pain self-efficacy.

Key Takeaways

Adding strengthening or motor control exercises to an educational intervention did not result in additional benefits compared to an approach based solely on education and advice. For some people with persistent shoulder pain, education and advice focusing on pain self-management may be sufficient to promote symptom resolution.

Exercise, in any form, remains a highly relevant intervention for shoulder pain management, as well as for maintaining independence and optimizing long-term health.

Participants’ pain self-efficacy and expectations of the effectiveness of the intervention they receive may play a role in the prognosis of their shoulder pain.

When you’re experiencing shoulder pain, it can be beneficial to temporarily reduce certain activities that can aggravate your pain. However, it’s important not to delay gradually reintegrating these activities into your daily routine.

The presence of pain, especially when it persists over time, is not necessarily a sign that your condition is deteriorating. It could simply indicate that the gestures or activities performed exceed the shoulder’s current ability to tolerate the load imposed on it.

In any case, don’t hesitate to consult a health professional, such as a physiotherapist, who will be able to help you “shoulder” the responsibility of managing your condition.

Marc-Olivier Dubé, PhD, is a Physiotherapist and Postdoctoral researcher in rehabilitation at Laval University.

Francois Desmeules, PhD, is a professor in physiotherapy and musculoskeletal health, School of Rehabilitation, University of Montréal.

Jean-Sébastien Roy, PhD, is a professor at the School of Rehabilitation Sciences, Laval University.

This article originally appeared in The Conversation and is republished with permission.

Pilot Study Shows Stem Cells Effective in Treating Shoulder Pain

By Pat Anson, PNN Editor

A single injection of stem cells has shown promise as a treatment for shoulder pain caused by rotator cuff disease, according to the results of a small pilot study conducted by the Kessler Foundation.

Ten wheelchair users with moderate to severe shoulder pain received an injection of adipose stem cells derived from their own fat tissue. The participants all had spinal cord injuries and chronic shoulder pain for at least six months that did not respond to conventional treatment.   

The stem cells were micro-fragmented using minimal manipulation to preserve fat clusters and the cells’ regenerative properties. This micro-fragmented adipose tissue (MFAT) was then injected into shoulder tendons under ultrasound guidance.

The study findings, recently published in the Journal of Spinal Cord Medicine, showed nearly 80 percent of participants had a significant decrease in pain symptoms, and all but one reported improvement in pain and function. Symptoms steadily improved over the course of a year, suggesting the injections have long-lasting effects. There were no significant adverse events.

"These results show that the minimally invasive injection of micro-fragmented adipose tissue is a safe and efficacious option for wheelchair users with shoulder pain caused by rotator cuff disease," said Gerard Malanga, MD, a founder of the New Jersey Regenerative Institute and a visiting scientist at the Kessler Foundation.

“We feel there is great potential for this therapy to help people with shoulder pain manage their symptoms and improve their quality of life.”

In addition to their regenerative properties, MFAT stem cells are believed to provide cushioning and to fill-in structural defects when injected into damaged shoulder joints.

Malanga and his colleagues are currently conducting a larger Phase 2 controlled study with 24 participants that will compare MFAT injections to corticosteroid injections for treating pain caused by rotator cuff disease or tears.        

Shoulder pain is a common occurrence among wheelchair users with spinal cord injuries because they rely solely on their upper limbs to perform everyday tasks. The pain is often caused by soft-tissue injuries such as inflamed rotator cuff tendons. Pain medication and physical therapy are typically used to treat shoulder pain, with surgery as a last resort – not a good option for someone with a spinal cord injury.

The New Jersey-based Kessler Foundation is a global leader in rehabilitation research and employment programs for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord.

Plasma Therapy Helps Rotator Cuff Injuries Heal

By Pat Anson, Editor

Kobe Bryant, Peyton Manning and Alex Rodriguez have used it to treat chronic injuries and extend their athletic careers. But does platelet-rich plasma therapy (PRP) work for amateur athletes and weekend warriors?

According to a small pilot study published in PLOS ONE, a single PRP injection helps reduce pain and heal injured tissue.in patients with chronically sore shoulders caused by rotator cuff tears. 

"We studied patients 35 to 60 years old with rotator cuff tendinopathy due to normal aging. For the first time, we were able to not only find reported improvements in pain and mobility, but also in the tissue - the MRI before and after showed structural change and a decrease in the size of tears," says lead author Marni Wesner, sports medicine physician at the University of Alberta’s Glen Sather Sports Medicine Clinic.

PRP therapy is an emerging therapeutic procedure for the treatment of both acute and chronic soft tissue injuries. The procedure involves withdrawing blood from the patient and then spinning it to produce a high concentration of platelet cells. The plasma is then injected back into the patient at the injury site, speeding up the natural healing process.

The pilot study involved only a small number of participants – 7 patients with rotator cuff tendinopathy received a PRP injection and 2 received a placebo injection. All participants then took part in a 3-month home-based daily exercise program.

"Based on MRI findings before and after the injections, we saw improvements in the tissue six months later in five of seven patients undergoing PRP and an appropriate rehabilitation program. The healing in the tissue appeared to correspond with the reported improvement of the pain and also with the clinical assessment of function," explains Doug Gross, interim chair of physical therapy at the Faculty of Rehabilitation Medicine.

One of the patients who benefitted from the treatment was Debbie Brown, a retired police officer.

"For the past two years, I have tried everything for my right shoulder. Physio would help for a bit but then the problem would still be there. I tried acupuncture, Kinesio tape, cortisol injections - you name it, I've tried it," says Brown. "Once I did the PRP, it really did fix everything!"

At age 58, Brown says her injured shoulder feels like new.

"I can shoulder-check now and brush my hair. I can work out and be active again," she says.

Researchers admit the small size of the study and other factors may have affected the results.

“Patients considered for this study had very high expectations of PRP treatment, with 70% willing to pay out-of-pocket for the therapy to avoid the possibility of receiving a placebo injection. This presented a serious challenge for recruitment and will likely limit the ability of future investigators to enroll sufficiently large and representative samples of patients for PRP trials. High patient expectations and the placebo effect on clinical outcomes also cannot be discounted,” said Wesner.

In fact, one of the patients who received placebo treatment reported improvements in both pain and physical function – which could have been a placebo response to the injection or because of the home exercise program they participated in.

Los Angeles Lakers star Kobe Bryant was one of the first professional athletes to receive PRP therapy, traveling to Düsseldorf, Germany for a more refined version known as the Regenokine treatment.  Peyton Manning, Alex Rodriquez, Vijay Singh and other professional athletes soon followed.

Only a few small clinical trials have been conducted on the effectiveness of PRP therapy. Patients with knee osteoarthritis showed significant improvements as long as two years after PRP injections, according to a study published in The Journal of the American Osteopathic Association.