ECSS Paris 2023: OP-MH21
INTRODUCTION: Exercise is recommended as first-line management for Rotator Cuff Related Shoulder Pain (RCRSP), yet factors influencing long-term outcomes following successful conservative treatment remain unclear (Lewis., 2016). In particular, the prognostic value of shoulder strength and biomechanics after discharge has not been established. The aim is to investigate the role of shoulder muscle strength and biomechanics in the long-term prognosis of RCRSP. METHODS: Twenty-one individuals who had recently completed successful conservative management for RCRSP and 21 age-, sex- and activity-matched controls were recruited. Baseline assessment included patient-reported outcome measures (QuickDASH, MSK-HQ, shoulder satisfaction), upper and lower limb muscle performance testing, and 3D kinematic and trapezius EMG analysis during active shoulder tasks and a functional lifting task. Participants with a history of RCRSP were prescribed a 9-month, experience-tailored resistance training programme. Training adherence and patient-reported outcomes were evaluated at 3, 6, and 9 months, with the full muscle performance and biomechanical assessment repeated at 9 months. Between-group differences were examined using independent t-tests. Measures of association and binary logistic regression analyses were employed to identify predictors of clinically meaningful deterioration (≥0.3 SD decline) in patient-reported outcomes over the 9-month follow-up period. RESULTS: Despite good clinical recovery at baseline, previously symptomatic participants exhibited significantly lower upper and lower limb muscle performance than controls, including performance on the single-leg sit-to-stand test and measures of shoulder abduction, external rotation, and internal rotation assessed using the ExtRA Capacity Tests and hand-held dynamometry. No baseline strength, kinematic, or EMG variables were predictive of long-term outcomes. Adherence to the resistance training programme emerged as the strongest predictor of a favourable prognosis (OR 2.02). Improvements in shoulder abduction and external rotation capacity, particularly as assessed by the ExtRA Capacity Test (Ford et al., 2025), were independently associated with reduced odds of symptom deterioration. CONCLUSION: Long-term prognosis following conservative management of RCRSP cannot be determined from discharge assessments alone. Sustained engagement in resistance training, with specific improvements in shoulder abduction and external rotation capacity, appears critical for maintaining favourable outcomes and reducing symptom recurrence. References: Lewis, J., 2016. Rotator cuff related shoulder pain: assessment, management and uncertainties. Manual therapy, 23, pp.57-68. Ford, H., Lewis, J., Tyros, V., Low, D. C., Bateman, W. R., Lee, Y., ... & Shaheen, A. F. (2025). The ExtRA Capacity Test: Reliability, validity and normative data of a new clinical tool for assessing shoulder muscle performance. Physiotherapy, 101868.
Read CV Aliah ShaheenECSS Paris 2023: OP-MH21
INTRODUCTION: Chronic low back pain (CLBP) is one of the leading causes of years lived with disability worldwide, as shown in the Global Burden of Disease Study [1]. Recent evidence indicates that CLBP is highly prevalent among older adults, with reported rates ranging from 21% to 75%.[2]. In this population, CLBP is frequently accompanied by sensorimotor impairments such as reduced postural control [3] and sleep disturbance[4]. These sensorimotor impairments are also related to an increase risk of falling in elderly [5]. Exercise therapy is considered a first line treatment for CLBP, aiming to improve the function of back extensor and abdominal muscles. Given the strong association between balance impairments and fall risk in older adults, balance exercises are recommended as an effective intervention to reduce the likelihood of falling. This study aimed to determine whether adding balance exercises to a trunk muscle training program reduces pain, improves sleep quality, and enhances sensorimotor control in older adults with chronic low back pain, compared to trunk training alone. METHODS: A single blinded randomized controlled trial with 40 participants (mean age 65, 16 men ) with chronic low back pain was conducted. The experimental group received trunk muscle and balance exercises, and the control group received trunk muscle exercises over a period of six weeks. Both groups exercised 2 times a week for one hour. Primary outcomes were pain and quality of sleep . Secondary outcomes were pressure pain threshold, back extensor muscle strength and balance performance measured with the y-balance test. RESULTS: Repeated measures ANOVA revealed significant time × group interactions for present pain [F (1,38) = 7.93, p < 0.01, partial η² = 0.08] and days without pain [F (1,38) = 3.91, p = 0.05, partial η² = 0.03], favouring the experimental group. Further, a significant time effect without a time*group effect [F (1,38) = 4.62, p = 0.04, partial η² = 0.003] was observed for sleep quality with lower mean values in the experimental group. However, exploratory within group analyses showed that sleep quality improved significantly in the experimental group (p <0.02), whereas no significant change was observed in the control group. Secondary outcomes (pressure pain threshold, Y balance performance and back extensor strength) showed significant time × group interactions, all favouring the experimental group [PPT: F(1,38) = 14.56, p < 0.01, η² = 0.04; Y balance: F(1,38) = 63.72, p < 0.01, η² = 0.05; back extensor strength: F(1,38) = 15.88, p < 0.01, η² = 0.01]. CONCLUSION: Adding balance to trunk training reduces pain and improves sensorimotor control in older adults with chronic low back pain. The selective pain reduction and sleep improvement in the balance group may relate to GABA‑mediated effects on postural control and sleep regulation. Overall, combined training shows clinically meaningful potential.
Read CV Konstantin BeinertECSS Paris 2023: OP-MH21
INTRODUCTION: Multiple sclerosis (MS) is commonly associated with persistent deficits in postural control, substantially limiting functional independence. Aligned with the “Exercise is Medicine” paradigm, movement-based interventions are increasingly regarded as integral to disease management, driving growing interest in evidence-based, non-pharmacological approaches to improve mobility. Hippotherapy has been proposed as a multimodal physiotherapeutic intervention targeting sensorimotor integration and postural regulation. However, biomechanical evidence based on objective outcome measures remains scarce. METHODS: Effects of hippotherapy on static balance control were examined in 61 individuals with MS (m = 5, f = 56, age ⌀ 55 ± 9.02 years, EDSS = 5 ± 0.7) after participating in a 12-week RCT (T1) with a 6-week follow up (T2) compared to before (T0), (Intervention group (IG) = 34, Control group (CG) = 27). IG received hippotherapy (DKThR)® additional to treatment as usual, CG received treatment as usual only. Center of pressure (CoP) analysis was applied during three standing conditions on a force plate: Quiet stance (eyes open and eyes closed) and narrow stance (eyes open) for 3 × 20 seconds each. CoP trajectories were quantified using the 95% confidence ellipse area of the CoP (area95), path length, sway amplitudes and mean CoP velocity. RESULTS: Linear mixed-effects models (LMMs) demonstrated intervention-related improvements across multiple postural sway parameters, characterized by significant time × group interactions and moderate to large effect sizes. For stance with eyes open, area95 LMMs revealed a significant time × group interaction (F(2, 116.89) = 4.32, p = .016). Estimated marginal means (EMMs) indicated a pronounced reduction in the IG from T0 to T1 (EMMs: 12.548 to 5.479) and sustained improvement at T2 (EMM: 6.730), whereas the CG showed no consistent changes. Holm-adjusted post-hoc contrasts confirmed improvements from T0 to T1 (Δ = 7.069, z = 3.37, p = .006, d = .83) and from T0 to T2 (Δ = 5.818, z = 2.70, p = .049, d = .68) in the IG only. For path length during the same condition, LMMs revealed a significant time × group interaction (F(2, 111.71) = 3.92, p = .023). EMMs indicated a pronounced reduction in the IG from T0 to T1 (EMMs: 45.450 to 33.937), which was maintained at T2 (EMM: 34.373), whereas the CG showed no consistent changes. Holm-adjusted post-hoc contrasts confirmed significant reductions in the IG from T0 to T1 (Δ=11.513, z = 2.95, p = .026, d = .73) and from T0 to T2 (Δ = 11.078, z = 2.76, p = .041, d = .70). CONCLUSION: The findings demonstrate statistically significant and sizable improvements in static balance control characterized by reductions in sway area, path length, and directional amplitudes, with partial maintenance at follow-up. These improvements may be functionally relevant, highlighting the potential of CoP-based measures for translating movement-based interventions into evidence-informed rehabilitation strategies for individuals with MS.
Read CV Isabel StolzECSS Paris 2023: OP-MH21