Shoulder impingement is a common cause of shoulder pain that responds well to active, therapeutic exercise. A more passive “shockwave treatment” has recently been used to treat impingement. This passive modality was compared with an active exercise treatment in shoulder impingement patients in Norway. The study published in the British Medical Journal compared 12 weeks of physiotherapy and home exercise using elastic tubing with 4 to 6 treatments of Radial Extracorporeal Shockwave Treatment (REST).

64% of the exercise patients and only 36% of the shockwave treatment patients had significant improvement in pain and disability, and more patients in the exercise group returned to work. Interestingly however, there were no significant differences between groups in function or range of motion.

This study is consistent with the findings of other studies that show elastic resistance exercises are effective as part of an active care approach to shoulder impingement that includes both clinic- and home-based exercises. Thera-Band® elastic resistance and patient kits are ideal to facilitate both clinical and home exercise programs.

Engebretsen K, et al. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. BMJ. 2009;339:b3360.

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In a study published in the Journal of Strength and Conditioning Research, researchers compared squatting with equivalent work loads of elastic-resisted and isotonic free-weight squats in trained weight lifters. Subjects squatted with each type of resistance while muscle activity and biomechanical variables were measured. The band-resisted squats resulted in higher force, velocity, power, and quadriceps muscle activity near the top of the squat, which includes the first part of the eccentric phase, as well as the last part of the concentric phase.

The researchers concluded that elastic resistance produces similar resistance patterns as standard free weights, except at the bottom of the squat, where the bands are on less stretch and thus, less tension.  More importantly, the researchers stated that elastic band squats “resulted in a kinetic and kinematic pattern similar to that of ballistic movement used for power training.” Although not proven in this study, using elastic resistance during the squat may maximize power output. The Thera-Band® Exercise Station may be an effective tool at improving muscular power because the elastic tubing produces highest amounts of resistance with maximal leverage at the top of the squat.

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Reference: Israetel MA, et al. Kinetic and kinematic differences between squats performed with and without elastic bands. J Strength Cond Res. 2010 Jan;24(1):190-4.

Dialysis patients often have reduced physical function and quality of life because of their disease complications and lack of physical activity. Unfortunately, there is little research on exercise in dialysis patients. Researchers performed a multi-center randomized controlled trial in Spain to determine the effects of a resistance training program with ankle weights and elastic bands.

27 hemodialysis patients were randomly assigned to a resistive-exercise group or a low-level aerobic exercise group. Both groups, supervised by physiotherapists, exercised 3 times a week for 6 months. Each session included 5 minutes of stretching as part of warm-up and cool down, and 25 minutes of either resistance training or stationary bike riding. The resistance training group performed training at an RPE of 12-14, and emphasized lower extremity exercise.

At the end of the study,  the resistance training group significantly increased in physical function compared to the control group. The researchers concluded that an exercise program including elastic resistance and ankle cuff weights was safe and effective for hemodialysis patients.

Segura-Ortí E, Kouidi E, Lisón JF. Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clin Nephrol. 2009 May;71(5):527-37.

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Researchers in Spain compared Thera-Band® elastic band strengthening to aquatic strengthening including Aquafins® aquatic training in a group of post-menopausal women. The subjects were randomly assigned to the elastic, aquatic, or non-exercising control group. The 24 week periodized program used the OMNI scale for perceived exertion to ensure both groups trained at the same intensity. Each group performed the same exercises with different types of resistance. After the training program, both the elastic and aquatic groups equally improved their body composition (12-15% reduction in body fat), blood pressure (6-8% reduction), physical capacity (13-52% improvement) and blood chemistry (11% increase in HDL) compared to the control group.

These results confirm that both dry land and aquatic training are effective and beneficial in middle-aged women. This information is particularly useful given the potential increase in aquatic exercise as the aging population increases. For example, older adults with arthritis may better tolerate a strengthening program with less impact in water, and Thera-Band elastic resistance offers more convenient and less expensive access to resistance training.

Colado JC, Triplett NT, Tella V, Saucedo P, Abellán J. Effects of aquatic resistance training on health and fitness in postmenopausal women. Eur J Appl Physiol. 2009 May;106(1):113-22.

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The debate of elastic resistance versus isotonic resistance

Elastic resistance is commonly used in rehabilitation exercises, and has been shown to increase strength and function in over 100 randomized controlled trials (www.thera-bandacademy.com). Even with this amount of clinical evidence, elastic resistance is sometimes criticized because of the difficulty in quantifying intensity. Despite the fact that force elongation charts are available to quantify elastic resistance intensity, it is sometimes difficult to use these clinically. Because of this limitation, few studies have compared elastic and isotonic resistance directly because of the intensity-dosing issue.

Quantifying EMG and RPE of elastic and isotonic resistance

Researchers in Denmark compared elastic and isotonic dumbbell resistances for muscle activation and perceived exertion levels. Healthy females performed 3 different exercises with standard dumbbells ranging from 2 to 7.5 kg, and Thera-Band elastic tubing (red, green, blue, black and silver).  The researchers developed a chart comparing isotonic and Thera-Band elastic resistance stretched 125 to 150%.

Each subject randomly performed 3 exercises with both types of resistance: standing lateral raise, shoulder external rotation at 0° of abduction, and seated wrist extension. The elastic tubing was stretched 125-150% during each exercise. Electromyographic (EMG) activity of neck, shoulder and forearm muscles was assessed during each exercise along with perceived loading using a Borg CR10 scale for rating of perceived exertion (RPE).

The investigators found no significant difference in muscle activation between isotonic and elastic resistance, noting increasing levels of muscle activation with increasing levels of resistance.  Interestingly, the researchers noted approximately a 10% increase in EMG activity between resistance levels in both conditions. In addition, the researchers found that perceived exertion was correlated with resistance level and EMG with both types of resistance. This means that clinicians might be able to use RPE to dose resistance at approximate EMG levels; however, this relationship needs to be validated in patient populations as well.

Elastics and isotonics exhibit similar biomechanics

These results are not surprising in light of the biomechanical and clinical data suggesting that elastic resistance is similar to isotonic resistance. Both types of resistance produce similar ‘bell-shaped’ strength curves (Hughes et al. 1999). Recently, researchers in Spain reported that elastic and isotonic resistance produce the same increases in strength and muscle mass (Colado et al. 2008). They also found that the OMNI RPE scale can be used effectively to dose elastic resistance exercise; therefore it seems that both the Borg CR10 and OMNI scales can be used effectively with Thera-Band elastic resistance.

Lead researcher Lars Andersen PhD and his colleagues concluded, “Comparable levels of muscle activation were obtained during resistance exercises with dumbbells and elastic tubing, indicating that therapists can choose either type in clinical practice.”

REFERENCE: Andersen LL, Andersen C, Mortensen OS, Poulsen OM, Bjornlund IBT, Zebis MK. Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Physical Therapy. 2010;90:538-549.

Disclaimer: The Thera-Band Academy provided elastic tubing for this study and did not provide monetary funding.

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