The Dose-Response Effect of Medical Exercise Therapy on Impairment in Patients with Unilateral Longstanding Subacromial Pain

Håvard Østerås*, 1, Tom Arild Torstensen2
1 Sør-Trøndelag University College, Faculty of Health Education and Social Work, Department of Physical Therapy, N-7004 Trondheim, Norway
2 Holten Institute, Lidingö, Sweden

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© Østerås and Torstensen; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Sør-Trøndelag University College, Faculty of Health Education and Social Work, Department of Physical Therapy, Ranheimsv 10, N-7004 Trondheim, Norway; Tel: +47 73 55 93 05; Fax: +47 73 55 93 51; E-mail:



The primary aim of this study was to investigate the effect of medical exercise therapy in shoulder impingement patients, along with possible correlations between impairment variables.

Study Design:

A prospective unblended randomized clinical trial.


Over four months, 61 participants were randomly assigned into a high-graded exercise therapy group (HD) (n=31) and into a low-graded exercise therapy group (LD) (n=30). Prognostic variables were similar between the groups at baseline. Five (8%) patients dropped out during the treatment period, and another four (6%) dropped out before followup. Pain was a composite score of a visual analogue scale (VAS). Isometric strength was measured during four resisted break tests on the shoulder. Function was measured by means of a functional assessment questionnaire (Shoulder Rating Questionnaire, SRQ). Both groups trained three times per week for twelve weeks, with tests pre- and posttraining and six months follow-up.


The HD group achieved significantly (p < 0.05) better outcome effects than the LD group for pain, range of motion, isometric functional strength and function, but both groups increased function from pretest to posttest.


In patients with uncomplicated subacromial pain syndrome, medical exercise therapy is an efficient treatment alternative, where high-grade doses should be emphasized. A major limitation is that the measurements were not undertaken by another person than the treating physiotherapists.

Keywords: Shoulder, rehabilitation, impingement, physical therapy, dose-response, muscle function..