Síndrome do impacto subacromial: considerações clínicas, biomecânicas e os efeitos da aplicação de diferentes cargas no treinamento resistido dos músculos das articulações escapulotorácica e glenoumeral

Abstract

Introduction: The treatment recommendations for shoulder are based on muscle resistance training program, whereas scapula stability may increase rotator cuff performance. However, the progression of the applied loads on resistence training, the relevance of their effects and the influence of scapular dyskinesis on shoulder muscle strength is unclear. Objective: To compare the effects of resistance training with and without progressive load increase on pain, function, quality of life, muscle strength, and scapular kinematics in subjects with SIS (study 1) and to compare the maximum isometric strength of the shoulder muscles among healthy young women with and without scapular dyskinesis (study 2). Methods: Randomized controlled trial and cross-sectional study. Seventy participants with SIS were allocated to one of two intervention groups. The interventions were based on strengthening exercises, with one group receiving progressive load readjustment and the other maintaining a minimal load. The primary outcome were pain intensity, disability, and function pre-treatment, 10, 22, and 34 weeks after randomization. The secondary outcomes were quality of life, global perceived effect, muscle strength, and scapular kinematics. The second study, 36 healthy women divided into two different groups, with scapular dyskinesis and without scapular dyskinesis. Results: Study 1. No between-group differences were observed in the primary outcomes over time, the mean differences were (95% CI), respectively, for pain intensity: -0.7 (-2.1;0.6), 0.0 (-1.3;1.3), 0.1 (-1.3;1.6); disability: -4.9 (-18.1;1.2), -2.6 (-16.1;10.8), -1.8(-12.2;15.7); and function: 8.7 (-2.0;19.5), 4.6 (-6.9;16.2), 0.2 (-12.3;12.7). Study 2. No significant differences were found in the muscle strength of the shoulder among healthy women with and without scapular dyskinesis. Between-group differences (95% CI) for all outcomes ranged from 0.1 (-2.1; 2.3) to 1.7 (-5.7; 2.2). Conclusion: No additional clinical benefit was observed in patients with SIS submitted to resistance training with progressive load increase when compared to the effects of exercise with minimal load. Scapular dyskinesis does not influence the ability of the major shoulder muscles to produce isometric muscle strength in healthy young women.