Consider these exercises for chronic musculoskeletal conditions
Exercise interventions reduce pain and improve function in knee/hip OA, chronic low back pain, shoulder pain, Achilles tendinopathy, and lateral epicondylitis.
PRACTICE RECOMMENDATIONS
› Consider quadriceps strengthening for knee osteoarthritis with an initial period of supervision, which can provide greater pain relief than nonspecific, unsupervised lower limb exercises. B
› Consider a generalized exercise program for subacromial impingement syndrome, to relieve shoulder pain and improve function, range of motion, and strength. A
› Bear in mind that the Alfredson protocol for Achilles tendinopathy has yielded improvement in pain and function for up to 5 years, although other exercise regimens have also proven initially effective. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
From The Journal of Family Practice | 2018;67(9):534-538,540-543.
The most common reported adverse effect of exercise is a temporary exacerbation of back pain. However, having patients continue daily activities within the permitted limits of pain leads to more rapid recovery than rest or back-mobilizing exercises.15,22,23
Cautions. Exercise is contraindicated in patients with LBP arising from a serious medical condition, such as fracture, infection, cancer, or cauda equina syndrome.24 Importantly, exercise interventions recommended for acute LBP have not shown benefit for chronic LBP.
Chronic shoulder pain
With a prevalence ranging from 7% to 26% in the general population,25 chronic shoulder pain often interferes with essential activities of daily living. The etiology of chronic shoulder pain is broad and most commonly involves disorders of the rotator cuff, which functions in both motion and dynamic stabilization of the shoulder. The common term “rotator cuff pain syndrome” can cover such disorders as subacromial impingement syndrome, rotator cuff tendinopathy or tendinitis, partial or full thickness rotator cuff tears, calcific tendinitis, and subacromial bursitis. These pathologies may have overlapping presentations. Manual therapy and exercise, usually delivered as a component of structured physical therapy, focus on stretches and other exercises to increase ROM, stability, and strength of the rotator cuff musculature.26
A 2016 Cochrane review that evaluated manual therapy and exercise for chronic shoulder pain yielded limited high-quality evidence for effectiveness compared with placebo.27 Five trials found no important differences between manual therapy and exercise compared with glucocorticoid injection relative to overall pain, function, active shoulder abduction, and quality of life from 4 weeks up to 12 months.27 But compared with placebo, exercise has been more effective in reducing reported pain, especially in the context of strengthening regimens focused on flexion, extension, and internal and external rotation.28
For subacromial impingement syndrome, a 2017 meta-analysis found that a generalized exercise program relieves pain and improves function, ROM, and strength.29 A generalized shoulder-strengthening program includes exercises that focus on internal and external rotation, horizontal abduction, and shoulder stabilization (FIGURE 3). These exercises can be completed with 3 sets of 15 to 20 repetitions, which create a fatigue response that improves strength and targets local muscular endurance.30
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