Powell Jared K, Schram Ben, Lewis Jeremy, Hing Wayne
Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia.
Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia.
Musculoskelet Sci Pract. 2022 Dec;62:102646. doi: 10.1016/j.msksp.2022.102646. Epub 2022 Aug 8.
Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain (RCRSP). Despite this, many fail to substantially improve with exercise-based treatment. Hence, expanding the current knowledge about the possible mechanisms of exercise for RCRSP is critical.
To synthesise the range of mechanisms proposed for exercise in people with RCRSP.
Scoping review METHODS: A systematic search of the Physiotherapy Evidence Database (PEDro) was conducted from inception to July 3, 2022. Two reviewers conducted the search and screening process and one reviewer extracted the data from each study. Randomised clinical trials using exercise for the management of RCRSP of any duration were included. The PEDro search terms used were "fitness training", "strength training", "stretching, mobilisation, manipulation, massage", "upper arm, shoulder, or shoulder girdle", "pain", and "musculoskeletal". Data were analysed using quantitative and qualitative approaches.
626 studies were identified and 110 were included in the review. Thirty-two unique mechanisms of exercise were suggested by clinical trialists, from which 4 themes emerged: 1) neuromuscular 2) tissue factors 3) neuro-endocrine-immune 4) psychological. Neuromuscular mechanisms were proposed most often (n = 156, 77%). Overall, biomedical mechanisms of exercise were proposed in 95% of cases.
The causal explanation for the beneficial effect of exercise for RCRSP in clinical research is dominated by biomedical mechanisms, despite a lack of supporting evidence. Future research should consider testing the mechanisms identified in this review using mediation analysis to progress knowledge on how exercise might work for RCRSP.
运动被认为是肩袖相关肩部疼痛（RCRSP）管理的关键且首要措施。尽管如此，许多患者经运动疗法治疗后并未得到显著改善。因此，拓展当前关于运动对RCRSP可能作用机制的认识至关重要。
综合分析针对RCRSP患者运动所提出的一系列作用机制。
范围综述
对理疗证据数据库（PEDro）从建库至2022年7月3日进行系统检索。两名研究者进行检索和筛选过程，一名研究者从每项研究中提取数据。纳入使用运动疗法治疗任何病程的RCRSP的随机临床试验。所使用的PEDro检索词为“体能训练”“力量训练”“拉伸、松动、手法治疗、按摩”“上臂、肩部或肩胛带”“疼痛”以及“肌肉骨骼”。采用定量和定性方法分析数据。
共识别出626项研究，110项纳入综述。临床试验者提出了32种独特的运动机制，从中归纳出4个主题：1）神经肌肉 2）组织因素 3）神经 - 内分泌 - 免疫 4）心理因素。神经肌肉机制被提及的频率最高（n = 156，77%）。总体而言，95%的病例提出了运动的生物医学机制。
尽管缺乏支持证据，但临床研究中运动对RCRSP有益作用的因果解释主要由生物医学机制主导。未来研究应考虑使用中介分析来检验本综述中确定的机制，以推进对运动如何作用于RCRSP的认识。
