Sousa, Catarina de OliveiraAugusto, Denise Dal'Ava2024-04-232023-12-21AUGUSTO, Denise Dal'Ava. Exercícios terapêuticos na tendinopatia do manguito rotador: prática clínica de fisioterapeutas brasileiros e efeitos do exercício isométrico em indivíduos afetados. Orientadora: Dra. Catarina de Oliveira Sousa. 2023. 107f. Tese (Doutorado em Fisioterapia) - Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2023.https://repositorio.ufrn.br/handle/123456789/58229Introduction: Dysfunctions in the tendons of the rotator cuff (RC), both symptomatic and asymptomatic, have a high prevalence in the general population. Conservative treatment is recommended for addressing tendinopathies and ruptures of the rotator cuff, especially resisted training that progressively imposes load on the tendon to assist in its repair by altering its metabolism and mechanical and structural properties. Among various forms of resistance, eccentric and concentric exercises have proven effective in improving overall shoulder function, and few studies have been conducted to assess the effects of isometric exercise on RC tendinopathy. Objectives: Study I = Investigate the use of therapeutic exercises by Brazilian physiotherapists in the management of rotator cuff tendinopathy. Study II = Investigate the effects of an isometric exercise protocol for the muscles of the rotator cuff, combined with stretching and strengthening exercises for shoulder muscles, on shoulder pain and function, strength, and electromyographic activity of the rotator cuff and shoulder muscles in individuals with rotator cuff tendinopathy. Methods: Study I = An online survey was conducted with a sample of 159 Brazilian physiotherapists. The survey comprised a combination of 62 open and closed-ended questions, divided into three sections: participants' demographic data, professional experience, and clinical practice in the rehabilitation of patients with rotator cuff tendinopathy. Study II = The second study was characterized as a case series involving eleven individuals (8 women and 3 men, aged 37.9±5.6 years) with rotator cuff tendinopathy. Participants engaged in isometric exercises for the rotator cuff, combined with stretching and strengthening of the shoulder complex muscles over a 6-week period. The treatment effects were assessed based on patient self-reported shoulder pain and function, isometric muscle strength, electromyographic activity of shoulder muscles during arm elevation and internal and external shoulder rotation, and pain during arm elevation before and immediately after the first intervention session and after 6 weeks of intervention. Results: Study I = Seventy-six percent of physiotherapists reported having a special interest in shoulder rehabilitation. The majority of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was significant variability in determining exercise volume, particularly for isometric exercises. In determining and progressing exercise load, most of our sample considered patient pain and comfort, regardless of the exercise type, with the majority (48.4%) recommending weekly reassessment and modification of exercises. Additionally, most physiotherapists would not interrupt exercises in case of pain during the early and late rehabilitation phases, despite pain being considered the main adverse effect of exercise and a discharge criterion. In addition to resisted exercises, physiotherapists also recommended other exercises and techniques in both the initial and advanced phases of rehabilitation, such as scapular stabilization exercises, shoulder mobility, and exercises for the cervical and thoracic spine. They also provided recommendations for home exercises, such as stretches and strengthening exercises for the rotator cuff muscles. Study II = After 6 weeks of intervention, there was a reduction in resting pain by 1.72 points (CI=-2.99–-0.44, d=1.20), pain during normal activities by 3.80 points (CI=-5.72–-1.88, d=1.76), and pain during strenuous activities by 3.10 points (CI=-5.02–-1.18, d=1.44), as assessed by the Penn. There was also an improvement in shoulder function both according to the Penn instrument (DM=15.7, CI=-27.3–-4.1, d=1.29) and the WORC (DM=410.9, CI=-76.0–-58.8, d=0.46). The results also showed an increase in isometric muscle strength for arm elevation (DM=3.24BW%, CI=0.17–6.31, d=0.45) and internal rotation (DM=3.98BW%, CI=0.31–7.65, d=0.49), an increase in muscle activity of the infraspinatus (DM=8.6%, CI=1.30–15.90, d=0.51) and serratus anterior (DM=12.1%, CI=4.34–17.86, d=0.60), and a reduction in pain during arm elevation (DM=1.99, CI=-3.64–-0.33, d=0.33). There was no difference between the initial assessment and immediately after the first intervention session for any of the variables.Acesso EmbargadoReabilitaçãoFisioterapiaDor no ombroDor subacromialManejo da dordoctoralThesisCNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL