Upgrading and Prophylactic Effect of Exercise in Shoulder Periarthritis

Abstract

There is a consensus about the benefit of exercise in shoulder periarthritis. However, there is uncertainty about the optimal combination of physical factors, the upgrading effect of exercise over physiotherapy and about the exercise parameters, such as frequency, intensity and duration. The aim of this study is to assess the upgrading effect of exercise. A two-week effect between two combinations of physical factors without exercise was compared versus the same double combinations of physical factors with exercise. To estimate the better combination between these two double physical factors, their two-week effect was compared. To evaluate the prophylactic effect of the frequency, the intensity and the duration of the home-prescribed exercise, these parameters were analysed after six months in all patients. Forty-eight outpatients (age 56.2±15.69 years) with shoulder periarthritis (pain initiation 3.39±3.15 months before recruitment) were treated for two weeks and followed up six months later. They were divided into four treatment groups of 12 patients. The first group was treated with magnetic field and electrophoresis with lidocaine. The second group received the same combination and exercise. The third group was treated with interferential current and laser. The fourth group received the same combination and exercise. The pain was recorded before and after the daily procedures by visual-analogue scale.  Before and after the two-week treatment course, shoulder range of motion and manual muscle testing were performed. After the treatment course, each patient was instructed to perform home-exercises. After six months follow-up the frequency, the intensity and the duration of the pain were recorded, as well as the frequency, the intensity and the duration of the home-exercises. ANOVA, correlation and regression analysis were applied in the statistical analysis. After the treatment course in all patients there was significant improvement regarding pain (P < 0.05), muscle strength (P < 0.05) and shoulder mobility (P < 0.05). The most significant results were recorded in the combination of interferential current, laser and exercises (P < 0.05); followed by the combination of interferential current and laser (P < 0.05); followed by the combination of electrophoresis, magneto-therapy and exercises (P < 0.05); and finally by the combination of electrophoresis and magneto-therapy (P < 0.05). There was an upgrading effect of exercise over physiotherapy (P > 0.05). There was a correlation between pain frequency and home-exercise frequency (P < 0.05). The pain frequency tended to zero at more than five times daily home-exercises (P < 0.05). Over the two-week therapeutic course the lowest pain and the highest mobility and strength showed the combination of interferential current, laser and exercises; followed by the combination of interferential current and laser; followed by the combination of electrophoresis, magneto-therapy and exercises; and finally the combination of electrophoresis and magneto-therapy. There was an upgrading effect of exercise over physiotherapy. Only the frequency of the exercise had a prophylactic effect. The incidence of pain tended to zero at exercise frequency over five times daily.