Consider these exercises for chronic musculoskeletal conditions

,; ,

Applied Evidence

Consider these exercises for chronic musculoskeletal conditions

J Fam Pract. 2018 September;67(9):534-538,540-543

PDF Download

From The Journal of Family Practice | 2018;67(9):534-538,540-543.

References

1. Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013;347:f5577.

2. Babatunde OO, Jordan JL, van der Windt DA, et al. Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLoS One. 2017;12:e0178621.

3. Persson G, Brorsson A, Ekvall Hansson E, et al. Physical activity on prescription (PAP) from the general practitioner’s perspective - a qualitative study. BMC Fam Pract. 2013;14:128.

4. Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66:622-636.

5. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376.

6. Fransen M, McConnell S, Hernandez-Molina G, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;(4):CD007912.

7. Vincent KR, Vincent HK. Resistance exercise for knee osteoarthritis. PM R. 2012;4(suppl 5):S45-S52.

8. Fernandes L, Storheim K, Nordsletten L, et al. Development of a therapeutic exercise program for patients with osteoarthritis of the hip. Phys Ther. 2010;90:592-601.

9. Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;(3):CD005523.

10. Jordan JL, Holden MA, Mason EE, et al. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010;(1):CD005956.

11. Baker KR, Nelson ME, Felson DT, et al. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol. 2001;28:1655-1665.

12. Brakke R, Singh J, Sullivan W. Physical therapy in persons with osteoarthritis. PM R. 2012;4:S53-S58.

13. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88(suppl 2):21-24.

14. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-530.

15. Hayden JA, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335.

16. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142:776-785.

17. Searle A, Spink M, Ho A, et al. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29:1155-1167.

18. Yamato TP, Maher CG, Saragiotto BT, et al. Pilates for low back pain. Cochrane Database Syst Rev. 2015;(7):CD010265.

19. Wieland LS, Skoetz N, Pilkington K, et al. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;(1):CD010671.

20. Parreira P, Heymans MW, van Tulder MW, et al. Back Schools for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;(8):CD011674.

21. Meng XG, Yue SW. Efficacy of aerobic exercise for treatment of chronic low back pain: a meta-analysis. Am J Phys Med Rehabil. 2015;94:358-365.

22. Malmivaara A, Häkkinen U, Aro T, et al. The treatment of acute low back pain--bed rest, exercises, or ordinary activity? N Engl J Med. 1995;332:351-355.

23. van Tulder M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group. Spine (Phila Pa 1976). 2000;25:2784-2796.

24. Hoffmann TC, Maher CG, Briffa T, et al. Prescribing exercise interventions for patients with chronic conditions. CMAJ. 2016;188:510-518.

25. Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73-81.

26. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18:138-160.

27. Page MJ, Green S, McBain B, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016;(6):CD012224.

28. van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2014;48:1216-1226.

29. Shire AR, Stæhr TAB, Overby JB, et al. Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis. BMC Musculoskelet Disord. 2017;18:158.

30. Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010;44:319-327.

31. Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009;19:54-64.

32. Rees JD, Wolman RL, Wilson A. Eccentric exercises; why do they work, what are the problems and how can we improve them? Br J Sports Med. 2009;43:242-246.

33. Alfredson H, Pietilä T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26:360-366.

34. Rompe JD, Nafe B, Furia JP, et al. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35:374-383.

35. Stevens M, Tan CW. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. J Orthop Sports Phys Ther. 2014;44:59-67.

36. Habets B, van Cingel RE. Eccentric exercise training in chronic mid-portion Achilles tendinopathy: a systematic review on different protocols. Scand J Med Sci Sports. 2015;25:3-15.

37. Malliaras P, Barton CJ, Reeves ND, et al. Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med. 2013;43:267-286.

38. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46:214-218.

39. Alizadehkhaiyat O, Fisher AC, Kemp GJ, et al. Pain, functional disability, and psychologic status in tennis elbow. Clin J Pain. 2007;23:482-489.

40. Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil. 2014;28:3-19.

41. Croisier JL, Foidart-Dessalle M, Tinant F, et al. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007;41:269-275.

42. Söderberg J, Grooten WJ, Ang BO. Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: a randomized-controlled trial. Scand J Med Sci Sports. 2012;22:797-803.

43. Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51:1679-1687.

Proposed treatment and rehabilitation options for patients with lateral epicondylitis have included massage, manipulation, taping, acupuncture, orthotic devices, ultrasound, activity modification, and rest. Exercise programs incorporating eccentric muscle activity are becoming increasingly popular for such conditions as Achilles and patellar tendinopathies, and they may translate well to other chronic tendinopathies, such as lateral epicondylitis.³²

An eccentric exercise program for lateral epicondylitis, either in isolation or as an adjunct to other therapies, has decreased pain and improved function and grip strength from baseline measures.⁴⁰ Compared with a standard exercise regimen without eccentric strength training, use of eccentric training improves such clinical measures as pain intensity and disability status, as it decreases tendon thickness and aids in recovering homogenous tendon structure.⁴¹

A sample exercise. The patient may sit in a chair and, with the forearm flexed and pronated over the edge of a table, grasp some form of resistance (bucket of water, training weight, resistance band) (FIGURE 5). The nonaffected hand can be used to help lift the affected wrist into full extension and then removed to allow lowering of the hand over several seconds into flexion. This activity can be performed in sets of 8 to 12 repetitions, 2 to 3 times a day, until the patient’s pain and function have improved.⁴²

Overcoming barriers to exercise

A major concern across all studies assessing the therapeutic value of exercise is patient compliance and adherence to prescribed programs. Compliance and adherence are affected in part by psychosocial factors such as low literacy and poor social support. From a physician’s perspective, direct and indirect costs of treatment and rehabilitation of chronic musculoskeletal conditions may discourage the prescribing of supervised physical therapy.³

Continuing daily activities within permitted limits of pain leads to more rapid recovery from low back pain than rest or back-mobilizing exercises.

Steps to consider in overcoming these barriers would be advising an exercise regimen that requires only an initial period of supervision; educating patients about the benefits of an exercise program; exploring a patient’s expectations, beliefs, and fears; and developing strategies for long-term adherence.¹⁶ Supervision through physical therapy is often suggested. However, significant barriers may exist that impede a patient’s ability to attend or participate, in which case physician observation in the course of regularly scheduled clinical examinations could be considered.

Continue to: When prescribing exercises...