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Background and Purpose: Rotator cuff weakness has been associated with subacromial pain syndrome (SAPS). The purpose of this study was to determine the effect of eccentric training, isolated to the shoulder external rotators, on strength, strength ratios, range of motion, upper quarter balance, pain, perceived function and global change.

Methods: Forty-Four participants, 19 females (mean age 46), with greater than 3 months of shoulder pain were randomized into two groups. The experimental group performed an external rotator eccentric training exercise (ETER) for three sets of 15 and a scapular retraction exercise, with a resistance band, for 2 sets of 10, once daily for six weeks. The control group utilized a general exercise program (GE), consisting of active range of motion and scapular retraction, with a resistance band, each for two sets of 10, once daily for six weeks. Dependent variables were compared within and between groups at baseline, week 3, and week 6.

Results: The factorial ANOVA demonstrated a significant difference for external rotation strength comparing the interaction between group and time (p<.001, ETER mean .160, GE mean .120). The factorial ANOVA did not demonstrate a significant difference for the upper quarter y balance test (p=.07- p=.32) and active range of motion (p=.17 - p=.77). The Mann-Whitney U test demonstrated significant differences for average pain (p=.022, median change ETER -2, GE -1), worst pain (p=.001, median change ETER -4, GE 0), Western Ontario rotator cuff index (p<.001, median ETER 91.40, GE 73.90), and global change (p<.001, median ETER +5, GE 0). Significant between group differences were not identified for the ANOVA, or ANCOVA controlling for worst pain, upon testing the internal rotator to external rotator (p=.46, p=.55), and abductor to external rotator (p=.32, p=.42) strength ratios.

Conclusions: This study identified the efficacy of eccentric training of the external rotators for individuals with SAPS, as evidenced by significant improvements for external rotation strength, pain, function and global change when compared to a control group.

Recommendations: Integrating eccentric training for the external rotators among individuals diagnosed with SAPS of greater than three months onset may improve outcomes including pain, strength, and function.


A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy from Nova Southeastern University, the College of Health Care Sciences, Physical Therapy Department.

Dissertation Committee: Dr. Morey J. Kolber (Chairperson), Dr. William J. Hanney, Dr. Stanley H. Wilson