Type of Exercise and Education in Patients With SubAcromial Pain Syndrome

Patients seeking care for their shoulder in a primary care setting will be recruited to
participate in a trial investigating the value of different exercise and education regimens.
Patients that choose to participate will be randomized to 1 of 4 different treatment groups
focused on strengthening of the rotator cuff and shoulder girdle muscles: eccentric
strengthening alone; traditional strengthening alone; eccentric strengthening plus education
focused on pain neuroscience, traditional strengthening plus education focused on pain
neuroscience. All patients will be seen in the clinic for 4-6 sessions over a 4-week period,
as well receive a home exercise program that aligns with the exercise group there were
randomized to.

One-year outcomes will be compared across all 4 groups.

Inclusion Criteria:

1. Age 18 to 65

2. Read and speak English well enough to provide informed consent, follow study
instructions, and independently answer the questionnaires/surveys

3. TRICARE beneficiary (eligible for medical benefits in the Military Health System)

4. Primary complaint of new episode of unilateral shoulder pain; defined as not having
sought care for shoulder condition in 6 months prior

5. Meets criteria for SAPS, as determined upon physical exam

6. At least 20% on either pain or disability subscales of the SPADI outcome measure

7. Available and willing to come in for treatment up to 8 sessions over a 4-week period

Exclusion Criteria:

1. History of shoulder dislocation, subluxation, fracture, adhesive capsulitis of the
glenohumeral joint, or cervical/shoulder/upper back surgery, or shoulder injury as the
result of trauma (e.g. fall, MVA)

2. Presence of cervical radiculopathy, radiculitis, or referral from cervical spine
(reproduces shoulder symptoms)

3. Patient reports their condition is "acceptable" on Patient Acceptable Symptom State
(PASS) at baseline

4. Anyone pending a medical evaluation board, discharge from the military for medical
reasons, or pending or undergoing any litigation for an injury

5. Unable to give informed consent to participate in the study.