Short-term effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomised controlled trial
Open accessAbstract
Objectives: To investigate the short-term effectiveness of high-load versus low-load strengthening exercise on self-reported function in patients with hypermobility spectrum disorder (HSD) and shoulder symptoms. Methods: A superiority, parallel-group, randomised trial (balanced block randomisation, electronic concealment) including adult patients (n=100) from primary care with HSD and shoulder pain and/or shoulder instability ≥3 months. Patients received 16 weeks of shoulder exercises (three sessions/week): HEAVY (n=50, full-range, high-load, supervised twice/week) or LIGHT (n=50, neutral/mid-range, low-load, supervised three times). The primary outcome was the 16-week between-group difference in self-reported function measured with the Western Ontario Shoulder Instability Index (WOSI, scale 0–2100, 0=best, minimal important difference 252 points). Secondary outcomes were self-reported measures including quality of life and clinical tests including shoulder muscle strength and range of motion. An intention-to-treat analysis with multiple imputation was conducted by a blinded biostatistician using linear regression. Results: 93 of 100 patients (93%) completed the 16-week evaluation. The mean WOSI score between-group difference significantly favoured HEAVY (−174.5 points, 95% CI −341.4 to −7.7, adjusted for age, sex, baseline score, clustering around clinic). The secondary outcomes were inconclusive, but patients in HEAVY were less likely to have a positive shoulder rotation test >180°, and more likely to rate an important improvement in physical symptoms. There were no serious adverse events, but HEAVY was associated with more transient muscle soreness (56% vs 37%) and headaches (40% vs 20%). Conclusion: High-load shoulder strengthening exercise was statistically superior to low-load strengthening exercise for self-reported function at 16 weeks and may be used in primary care to treat patients with HSD and shoulder pain and/or instability to improve shoulder function in the short term. Further studies are needed to confirm the clinical relevance, and patients should be supported to manage associated minor adverse events. Trial registration number: NCT03869307 .
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A randomized trial of 100 adult patients demonstrated that after 16 weeks of therapy, high-load shoulder strengthening exercise was statistically superior to low-load strengthening exercise for self-reported function.
“A randomized trial of 100 adult patients demonstrated that after 16 weeks of therapy, high-load shoulder strengthening exercise was statistically superior to low-load strengthening exercise for self-reported function.[63]”
From Hypermobility spectrum disorders: A review (2023) · cites this paper as [63]
No serious adverse events were noted in a randomized trial of high-load versus low-load shoulder strengthening exercise.
“No serious adverse events were noted.”
From Hypermobility spectrum disorders: A review (2023) · cites this paper as [63]
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Hypermobility spectrum disorders: A review
Carroll, M. B. (2023) · Rheumatology and Immunology Research · doi:10.2478/rir-2023-0010 · Cited by 45 · see citing works
- Authors
- Liaghat, B., Skou, S. T., Søndergaard, J., Boyle, E., Søgaard, K., & Juul-Kristensen, B.
- Affiliations
- University of Southern Denmark (DK)
- Corresponding author
- Liaghat, Behnam
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2022-06-01
- Volume
- 56
- Issue
- 22
- Pages
- 1269-1276
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- PMC
- PMC9626913
- OpenAlex
- W4281764601
- Cited by
- 27
- References
- 70
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 10 · 2023: 5 · 2022: 1
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Sports Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by-nc)
- Funders
- Fund for Research, Quality and Education in Physiotherapy Practice
- University of Southern Denmark
- Region of Southern Denmark
- Esbjerg municipality
- Danish Rheumatism Association
- Topics
- Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- hypermobility spectrum disorders, shoulder instability, shoulder pain, shoulder function, Western Ontario Shoulder Instability Index, muscle strength, range of motion, primary care
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