Supervised exercises in relation to rotator cuff disease (impingement syndrome stages II and III): A treatment regimen and its rationale

Abstract

The aim of this paper is to describe a physiotherapy method for treatment of patients with rotator cuff disease (impingement syndrome stages II and III). A comprehensive treatment programme based on biomechanics and the physiology of collagen tissue was designed in 1981. This method, which we call ‘supervised exercises’, is discussed in relation to recent biomechanical knowledge and clinical studies. ‘Supervised exercises’ emphasises reduction of mechanical subacromial stress, relearning of normal patterns of movement, specific endurance training to increase nutrition of the collagen tissue and simple advice to prevent relapse. In the presence of a positive impingement sign and test, a functional diagnosis is mandatory to pinpoint the cause of impingement as a guideline for an individual treatment programme. Reactivating the supraspinatus muscle to improve the initial movement pattern in abduction, together with promotion of agility of movement, are central elements of ‘supervised exercises’. Two large clinical studies have evaluated the treatment effect. A randomised, controlled study suggests that the supervised exercise regimen has a causative effect. The mechanisms are not clear and should be addressed in future studies.