shoulder_impingementLast year, I reported on a study from Norway comparing elastic resistance exercises with shockwave therapy in patients with shoulder pain. In that 2009 study, the researchers reported on the outcomes of 194 patients randomly assigned to 12 weeks of exercise using elastic resistance or 4 to 6 treatments of radial extracorporeal shockwave treatment (RESWT). Their paper reported on the 18-week outcomes, finding nearly twice as many subjects in the exercise group significantly improved their pain and disability levels compared to the shockwave group (64% vs. 36%). In addition, there were no significant differences between the groups in function or range of motion. Download the exercise protocol here.

Recently, Engebretsen and colleagues provided their 1-year follow-up in the journal Physical Therapy. One year after the intervention, there was no significant difference between the groups: both the exercise and RESWT groups significantly improved in pain levels, disability, function, and range of motion. In other words, while the shockwave therapy was less effective than exercise in the short term, there were no long-term differences between the treatments.

The authors noted a greater tendency of patients in the exercise group to return to work and to require fewer additional treatments than the RESWT group. Unfortunately, the authors did not perform a cost-benefit analysis, but suggested that RESWT may be associated with higher socio-economic costs. While the study provided an excellent follow-up rate (less than 10% of the subjects were lost at 1-year follow-up), its design was limited by lack of a true control group. Despite this limitation, it appears that elastic resistance exercises including Thera-Band® resistance bands can be as effective as RESWT for treating subacromial pain such as shoulder impingement in the long term, although exercise may have better short-term results and greater socioeconomic benefit.

REFERENCE: Engebretsen K, et al. Supervised exercises compared with radial extracorporeal shock-wave therapy for subacromial shoulder pain: 1-year results of a single-blind randomized controlled trial. Phys Ther. 2011 Jan;91(1):37-47.

Visit the Thera-Band Academy Shoulder Impingement Resource Center Here

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