#PTonICE Podcast Episode 701 - Creative dosage for subacromial shoulder pain
May 26, 2020
Practical approaches to dosing exercise for subacromial shoulder pain are explored. Tactics for acute, subacute, and chronic stages are outlined in short, actionable progressions. Different contraction types and training formats are discussed, plus scapulothoracic and thoracic considerations. A sample circuit and strategies to boost patient self-loading and adherence are presented.
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Exercise Is Primary But Dosage Is Unknown
- Exercise is the primary validated treatment for subacromial (rotator cuff) related shoulder pain according to recent systematic reviews.
- Reviews confirm exercise works but repeatedly call out missing specifics on dosage: reps, sets, frequency, and overall duration.
Eccentric Trials Mirror Concentric Dosage And Lack Intensity
- Existing RCTs on eccentric training for subacromial pain show little difference versus concentric work and overall small clinical gains.
- The trials used similar dosages (12–15 reps, three sets, daily or twice daily) but often lacked explicit eccentric timing and rarely loaded above ~80% 1RM.
Under-Dosing May Explain Weak Eccentric Trial Results
- A likely reason eccentric trials underperform is under-dosing intensity and not specifying eccentric/isometric timing.
- Dr. Hughey suggests trials should test >80% 1RM equivalents and longer eccentric durations for better outcomes.