Does Exercise Type Matter in Rotator Cuff Tendinopathy? A Focused Comparative Review of Randomized Controlled Trials
Abstract
Background: Rotator cuff tendinopathy is a common cause of shoulder pain and functional limitation. Exercise therapy is widely recommended as a conservative intervention; however, uncertainty remains regarding whether specific exercise approaches provide superior clinical outcomes. Objective: This focused comparative review examined two randomized controlled trials by Heron et al. (2016) and Dejaco et al. (2017), with emphasis on participant characteristics, exercise interventions, outcome measures, methodological considerations, and clinical outcomes. Methods: Two randomized controlled trials involving a combined sample of 156 participants were selected for focused comparison because they evaluated contrasting exercise-based rehabilitation strategies for rotator cuff tendinopathy. Data on participant characteristics, exercise protocols, intervention duration, outcome measures, and reported treatment effects were extracted from the published articles and synthesized narratively. The review was designed as a focused comparative synthesis rather than an exhaustive systematic review. Results: Heron et al. (2016) compared minimally loaded range-of-motion, open-chain loading, and closed-chain loading exercises, whereas Dejaco et al. (2017) compared eccentric exercise with conventional exercise therapy. Both trials reported improvements in shoulder-related pain and/or function following exercise-based rehabilitation. However, neither trial demonstrated statistically significant between-group differences sufficient to establish the superiority of a particular exercise approach. Conclusion: The two trials support exercise-based rehabilitation as a reasonable conservative approach for rotator cuff tendinopathy, but they do not establish the superiority of one specific exercise strategy. Exercise selection may therefore consider individual symptoms, functional goals, tolerance, and appropriate progression of loading. Further adequately powered randomized controlled trials with comparable outcome measures and longer follow-up periods are needed to determine whether particular exercise strategies provide clinically meaningful advantages.