Macías-Hernández Salvador Israel, García-Morales Jessica Rossela, Hernández-Díaz Cristina, Tapia-Ferrusco Irene, Velez-Gutiérrez Oscar Benjamín, Nava-Bringas Tania Inés
Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
Postgraduate Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
J Clin Orthop Trauma. 2020 Aug 3;14:106-112. doi: 10.1016/j.jcot.2020.07.031. eCollection 2021 Mar.
Rotator cuff tears are the main cause of shoulder pain and disability. First line of treatment is conservative; there is evidence regarding the advantage of using eccentric over concentric exercises in tendinopathies, but there are no evidence-based recommendations on starting strengthening exercise during painful phases nor on the effectiveness and advantages of eccentric vs. concentric exercise in rotator cuff tears.
To evaluate the tolerance of a resistance strengthening program and to compare eccentric vs. concentric programs.
A pilot, experimental, randomized controlled study.
Outpatient Rehabilitation Center.
Twenty-six patients with a diagnosis of partial rotator cuff tear were randomly assigned to: the experimental group (eccentric, = 12) and the control (concentric, = 14).
The experimental group performed muscle strengthening with eccentric technique directed to shoulder and scapular girdle muscles, while the control group performed the concentric technique.
Visual Analogue Scale (VAS), Constant Scale, Strength, Structure (Ultrasound report).
The tolerance rate was 96% in both groups. Median age (experimental vs. control) was 54.5 vs. 54 years ( = 0.69). Results at baseline, and at months 1, 3, and 12 (median) were as follows: for VAS (mm), experimental: 55, 30, 30, and 10, < 0.001 (intra-group); control: 50, 30, 30, and 5, = 0.01; Constant scale (points): experimental 58.5, 88, 93, and 85, < 0.001; control 50.62, 80, and 91.5, = 0.038; normalized strength (Kg); experimental: 0.23, 0.29, 0.73, and 0.72, = 0.001, and control: 0.24, 0.21, 0.54, and 0.66, = 0.01. We found inter-group differences in the Constant scale at 1 and 3 months ( < 0.05), and in strength at months 1 and 3 ( < 0.05). We observed structural differences in tendon (healing) between groups at 3 and 12 months.
Eccentric and concentric strengthening were well tolerated; both show early improvement in pain, functionality and tendon structure. Eccentric training appears to be more effective than concentric in the early improvement of functionality, strength and tendon healing.
肩袖撕裂是肩部疼痛和功能障碍的主要原因。一线治疗方法是保守治疗；有证据表明在肌腱病中使用离心运动比向心运动更具优势，但对于在疼痛阶段开始进行强化锻炼以及离心运动与向心运动在肩袖撕裂中的有效性和优势，尚无基于证据的建议。
评估阻力强化训练计划的耐受性，并比较离心训练计划与向心训练计划。
一项试点、实验性、随机对照研究。
门诊康复中心。
26例诊断为部分肩袖撕裂的患者被随机分为：实验组（离心运动，n = 12）和对照组（向心运动，n = 14）。
实验组采用针对肩部和肩胛带肌肉的离心技术进行肌肉强化训练，而对照组采用向心技术。
视觉模拟量表（VAS）、Constant量表、力量、结构（超声报告）。
两组的耐受率均为96%。中位年龄（实验组与对照组）分别为54.5岁和54岁（P = 0.69）。基线时以及第1、3和12个月（中位数）的结果如下：对于VAS（mm），实验组：55、30、30和10，P < 0.001（组内）；对照组：50、30、30和5，P = 0.01；Constant量表（分）：实验组58.5、88、93和85，P < 0.001；对照组50.62、80和91.5，P = 0.038；标准化力量（kg），实验组：0.23、0.29、0.73和0.72，P = 0.001，对照组：0.24、0.21、0.54和0.66，P = 0.01。我们发现两组在第1和3个月的Constant量表（P < 0.05）以及第1和3个月的力量（P < 0.05）存在组间差异。我们观察到两组在第3和12个月时肌腱（愈合）的结构差异。
离心和向心强化训练耐受性良好；两者在疼痛、功能和肌腱结构方面均显示出早期改善。在功能、力量和肌腱愈合的早期改善方面，离心训练似乎比向心训练更有效。
