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Clinical Trial of Exercise for Shoulder Pain in Chronic Spinal Injury

DA Nawoczenski, PT, PhD, is Professor, Department of Physical Therapy, Ithaca College–Rochester Campus, 1100 S Goodman St, Rochester, NY 14620 (USA)
JM Ritter-Soronen, PT, DPT, is Staff Physical Therapist, Adventist Rehabilitation Hospital of Maryland, Rockville, Md
CM Wilson, PT, DPT, is Staff Physical Therapist, Christiana Care Center for Rehabilitation, Wilmington Hospital, Wilmington, Del
BA Howe, PT, MSPT, is Graduate Research Assistant, Department of Physical Therapy, Ithaca College–Rochester Campus
PM Ludewig, PT, PhD, is Associate Professor, Program in Physical Therapy, Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, Minn

Address all correspondence to Dr Nawoczenski at: dnawoczenski{at}ithaca.edu

Background and Purpose. The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. Subjects. Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. Methods. The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User’s Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. Results. Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. Discussion and Conclusion. A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.

Key Words: Exercise • Motor performance • Physical therapy techniques • Shoulder pain • Spinal cord injuries

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