Progressive high-load strengthening exercise for the ‘hypermobile shoulder’: a randomised controlled trial

Research Objectives: To investigate the short-term effectiveness of high-load vs. low-load strengthening exercise in patients with generalized joint hypermobility (GJH) and shoulder complaints.

Design: A superiority, parallel group, randomized controlled trial (1:1 allocation ratio, electronic concealment, random block size) was conducted. The primary end point was 16-week follow-up.

Setting: The setting was primary care in the Region of Southern Denmark, Denmark.

Participants: We included adult patients (n=100) with GJH and shoulder pain and/or shoulder instability for at least three months.

Interventions: Participants received shoulder exercises three times/week for 16 weeks including high-load (n=50, full range, supervised twice/week) or low-load (n=50, mid-range, supervised three times in total).

Main Outcome Measures: The primary outcome was the between-group difference at 16 weeks in the Western Ontario Shoulder Instability Index score (WOSI, 0 to 2100 points, 0 = best). Secondary outcomes included self-reported measures and clinical tests. Outcome assessors were blinded to group allocation. Blinded intention-to-treat analysis was conducted using linear regression.

Results: In total, 93 out of 100 patients (93%) completed the 16-week follow-up. The between-group difference in mean WOSI total score significantly favoured high-load (-174.5 points, 95% CI -341.4 to -7.7, adjusted for age, sex, baseline WOSI score, and the clustering around clinics). The secondary outcomes total shoulder rotation >180° and Global Perceived Effect favoured high-load. There were no serious adverse events, but high-load had more transient muscle soreness and headaches.

Conclusions: High-load was superior to low-load and therefore recommended as treatment in patients with GJH and shoulder complaints to alleviate shoulder symptoms and improve function. Patients should be supported in managing minor adverse events.

Author(s) Disclosures: The authors declare no conflicts of interest related to this work.