Is Extracorporeal Shockwave Therapy Combined With Isokinetic Exercise More Effective Than Extracorporeal Shockwave Therapy Alone for Subacromial Impingement Syndrome? A Randomized Clinical Trial.

Study Design Single-blind randomized trial. Background Extra corporeal shock wave therapy (ESWT) has been shown to produce good results in the treatment of subacromial impingement syndrome (SAIS). The efficacy of a combined administration of ESWT and isokinetic exercise (IE) has not yet been studied. Objectives To evaluate the effectiveness of focused ESWT combined with IE for the rotator cuff versus ESWT alone in the treatment of SAIS. The secondary objective was to assess the isokinetic torque recovery (external rotation at 210, 180, and 120 degrees/second). Methods Thirty participants with SAIS were randomly assigned to a focused ESWT group or focused ESWT plus IE group. Subjects of both groups received three treatment sessions of focused ESWT over a period of ten days. Participants to the second group received also IE for ten therapy sessions. Outcome measures were the Constant-Murley Scale (CMS), the Visual Analogue Scale (VAS), and isokinetic parameters (peak torque and total work calculated from 5 repetitions) measured with the isokinetic test. Subjects were assessed at baseline, ten days after the last treatment session with focused ESWT, and after two months of follow-up. Results At the two months post-treatment, participants to the focused ESWT plus IE group showed significantly less pain (VAS, focused ESWT group: 3.4±0.8 vs. focused ESWT plus IE: 1.5±0.5, p<.001), with improvement of functionality (CMS, focused ESWT group: 75.9±6.7 vs. focused ESWT plus IE B: 92.1±6.3, p<.001) and muscle endurance than the subjects of the focused ESWT group. Conclusions In subjects with SAIS, combined administration of focused ESWT and IE for rotator cuff resulted in reduced pain, as well as a successful functional recovery in the short to medium term