Low level laser therapy versus eccentric exercises in the treatment of shoulder impingement syndrome
Background: Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain, accounting for 44-65% of all shoulder pain complaints. Many factors have been reported in the etiology of SIS, as narrowing of the subacromial space and the enlargement of the subacromial structures including bursae and/ or tendons. Physiotherapy should not only focus on decreasing pain, but should be additionally directed to the tendon degeneration. The eccentric exercises were used successfully to treat tendinopathies; the positive clinical effect of the eccentric exercises was correlated to normalization of tendon structure. In addition, low level laser therapy (LLLT) is also evident in SIS, the positive clinical effect of LLLT was also correlated to its beneficial effects in tissue regeneration. Objective: to investigate the effect of the eccentric exercises added to the scapular and the rotator cuff muscles strengthening and flexibility exercises versus LLLT added to the same exercises used in the first group in SIS patients. Subjects: Thirty patients diagnosed as right unilateral SIS for at least 3 months and a maximum of 6 months from the onset, age ranged from 25- 45 years, from both genders. They were divided into 2 groups, group A (11 females, 4 males) received the eccentric exercises in addition to flexibility and strengthening exercises and group B (8 females and 7 males) received LLLT in addition to the same flexibility and strengthening exercises. Both groups received 4 weeks of training. Methods: Patients were evaluated pre and post treatment for pain, and supraspinatus tendon structure (echo-texture) using visual analogue scale and ultrasonography (US) respectively. Results: There was significant improvement in both groups for pain and tendon structure with no significant difference between them. Conclusion: The results proved that both eccentric exercises and LLLT are effective in the treatment of SIS when added to scapular and rotator cuff strengthening and flexibility exercises. Contribution of paper: This is the first study that investigated the effect of the eccentric exercises on supraspinatus tendon structure. This is the first study that investigated the effect of LLLT on supraspinatus tendon structure.
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