ORIGINAL PAPER
Effect of Pilates exercises and diaphragm manual therapy techniques in rotator cuff tendinopathy
1
Ministry of Health and Population, Egypt
2
Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
3
Lotus University, Al Minya, Egypt
4
Al-Salhiya New University, Al-Salhiya, Egypt
5
Orthopaedic Department in Imbaba General Hospital, Giza, Egypt
Submission date: 2025-02-15
Acceptance date: 2025-05-08
Online publication date: 2026-03-06
Corresponding author
Mona Samir Ismail Al Shahawy
Basic Science Department, Faculty of Physical Therapy, 7 Ahmed El-Zayat Street, Bein El-Sarayat, Dokki, Giza, Egypt
Basic Science Department, Faculty of Physical Therapy, 7 Ahmed El-Zayat Street, Bein El-Sarayat, Dokki, Giza, Egypt
KEYWORDS
Pilates exercisesrotator cuff tendinopathydiaphragm manual therapy techniquesconventional physical therapydiaphragm stretchdiaphragm release
TOPICS
ABSTRACT
Introduction:
Rotator cuff tendinopathy is one of the highest prevalence musculoskeletal problems resulting from extrinsic factors or intrinsic pathology. Management includes diaphragmatic myofascial release and Pilates exercise. Pilates exercise is an individualised programme designed to improve shoulder ROM, strength and pain, while diaphragm manual therapy decreases shoulder pain and improves ROM. The shoulder muscles and diaphragm are connected via the myofascial system and the phrenic nerve link. The aim of this study was to investigate the effect of a Pilates exercise programme combined with diaphragm manual therapy techniques on pain intensity, pain threshold, shoulder muscle strength, and shoulder function in subjects with rotator cuff tendinopathy.
Methods:
A randomised clinical trial (single-blind design) was performed on 60 participants with chronic rotator cuff tendinopathy. They were randomly assigned (simple coin-flip method) into four equal groups. Group A received a Pilates exercise programme and conventional physical therapy. Group B received diaphragm manual therapy and conventional physical therapy. Group C received diaphragm manual therapy and a Pilates exercise programme in addition to conventional physical therapy. Group D received conventional physical therapy. The primary outcome was pain measured by VAS and pressure algometer. Secondary outcomes were shoulder muscle strength measured by handheld dynamometer, shoulder function measured by the Arabic version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and functional exercise capacity measured by the 6-minute walk test. Measurements were taken before and after the 8-week treatment (3 sessions/week) programme.
Results:
The pre-treatment results showed no differences between groups, while post-treatment, Group C showed significant improvement over groups A, B, and D in all variables: pain intensity, pain threshold, muscle strength, shoulder function, and exercise capacit.
Conclusions:
A Pilates exercise programme combined with diaphragm manual therapy is more effective than either of them alone in relieving pain, promoting and improving the functional activity of the shoulder, and increasing muscular strength in subjects with rotator cuff tendinopathy.
Rotator cuff tendinopathy is one of the highest prevalence musculoskeletal problems resulting from extrinsic factors or intrinsic pathology. Management includes diaphragmatic myofascial release and Pilates exercise. Pilates exercise is an individualised programme designed to improve shoulder ROM, strength and pain, while diaphragm manual therapy decreases shoulder pain and improves ROM. The shoulder muscles and diaphragm are connected via the myofascial system and the phrenic nerve link. The aim of this study was to investigate the effect of a Pilates exercise programme combined with diaphragm manual therapy techniques on pain intensity, pain threshold, shoulder muscle strength, and shoulder function in subjects with rotator cuff tendinopathy.
Methods:
A randomised clinical trial (single-blind design) was performed on 60 participants with chronic rotator cuff tendinopathy. They were randomly assigned (simple coin-flip method) into four equal groups. Group A received a Pilates exercise programme and conventional physical therapy. Group B received diaphragm manual therapy and conventional physical therapy. Group C received diaphragm manual therapy and a Pilates exercise programme in addition to conventional physical therapy. Group D received conventional physical therapy. The primary outcome was pain measured by VAS and pressure algometer. Secondary outcomes were shoulder muscle strength measured by handheld dynamometer, shoulder function measured by the Arabic version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and functional exercise capacity measured by the 6-minute walk test. Measurements were taken before and after the 8-week treatment (3 sessions/week) programme.
Results:
The pre-treatment results showed no differences between groups, while post-treatment, Group C showed significant improvement over groups A, B, and D in all variables: pain intensity, pain threshold, muscle strength, shoulder function, and exercise capacit.
Conclusions:
A Pilates exercise programme combined with diaphragm manual therapy is more effective than either of them alone in relieving pain, promoting and improving the functional activity of the shoulder, and increasing muscular strength in subjects with rotator cuff tendinopathy.
REFERENCES (41)
1.
Kuhn JE. Prevalence, natural history, and nonoperative treatment of rotator cuff disease. Oper Tech Sports Med. 2023;31(1):150978; doi: 10.1016/j.otsm.2023.150978.
2.
Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012;98(2):101–9; doi: 10.1016/j.physio.2011.08.002.
3.
Lewis J, Mccreesh K, Roy JS, Ginn K. Rotator cuff tendinopathy: navigating the diagnosis-management conundrum. J Orthop Sport Phys. 2015;45(11):923–37; doi: 10.2519/jospt.2015.5941.
4.
Via AG, De Cupis M, Spoliti M, Oliva F. Clinical and biological aspects of rotator cuff tears. Muscles Ligaments Tendons J. 2013;3(2):70–9; doi: 10.11138/mltj/2013.3.2.070.
5.
Desmeules F, Boudreault J, Roy JS, Dionne C, Fremont P, MacDermid JC. The efficacy of therapeutic ultrasound for rotator cuff tendinopathy: a systematic review and meta-analysis. Phys Ther Sport. 2015;16(3):276–84; doi: 10.1016/j.ptsp.2014.09.004.
6.
Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil. 2006;16(1):7–25; doi: 10.1007/s10926-005-9003-2.
7.
Desmeules F, Boudreault J, Dionne CE, Fremont P, Lowry V, MacDermid JC, Roy J-S. Efficacy of exercise therapy in workers with rotator cuff tendinopathy: a systematic review. J Occup Health. 2016;58(5):389–403; doi: 10.1539/joh.15-0103-RA.
8.
Atılgan E, Aytar A, Çağlar A, Tığlı AA, Arın G, Yapalı G, Kısacık P, Berberoğlu U, Şener HÖ, Ünal E. The effects of Clinical Pilates exercises on patients with shoulder pain: a randomised clinical trial. J Bodyw Mov Ther. 2017;21(4):847–51; doi: 10.1016/j.jbmt.2017.02.003.
9.
Akbaş Eda, Erdem EU. Does pilates-based approach provide additional benefit over conventional physiotherapy in the management of rotator cuff tendinopathy? A randomised controlled trial. J Ann Sports Med Res. 2016;3(6):1083; doi: 10.47739/2379-0571/1083.
10.
Fernández-López I, Peña-Otero D, Eguillor-Mutiloa M, Bravo-Llatas C, Atín-Arratibel MA. Manual therapy on the diaphragm is beneficial in reducing pain and improving shoulder mobility in subjects with rotator cuff injury: a randomized trial. Int J Osteopath Med. 2023;50:100682–2; doi: 10.1016/j.ijosm.2023.100682.
11.
Yamamoto-Morimoto K, Horibe S, Takao R, Anami K. Positive effects of yoga on physical and respiratory functions in healthy inactive middle-aged people. Int J Yoga. 2019;12(1):62–7; doi: 10.4103/ijoy.IJOY_10_18.
12.
Gumina S, Candela V, Passaretti D, Latino G, Venditto T, Mariani L, Santilli V. The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2014;23(11):1669–74; doi: 10.1016/j.jse.2014.03.016.
13.
Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–7; doi: 10.1111/j.1553-2712.2001.tb01132.x.
14.
Khatri A, Kalra N. A Comparison of two pain scales in the assessment of dental pain in east Delhi children. ISRN Dent. 2012;2012:247351; doi: 10.5402/2012/247351.
15.
Analan PD, Leblebici B, Adam M. Effects of therapeutic ultrasound and exercise on pain, function, and isokinetic shoulder rotator strength of patients with rotator cuff disease. J Phys Ther Sci. 2015;27(10):3113–7; doi: 10.1589/jpts.27.3113.
16.
Jones DH, Kilgour RD, Comtois AS. Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women. J Pain. 2007;8(8):650–6; doi: 10.1016/j.jpain.2007.04.003.
17.
Ko SJ, Kim H, Kim SK, Park K, Lee J, Lee B-J, Oh J, Lee K, Park J-W. Reliability and validity of modified algometer in abdominal examination. Evid Based Complement Alternat Med. 2016;2016:3052954; doi: 10.1155/2016/3052954.
18.
Wolf EM, Agrawal V. Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears. J Shoulder Elbow Surg. 2001;10(5):470–3; doi: 10.1067/mse.2001.117126.
19.
De Groef A, Van Kampen M, Vervloesem N, Clabau E, Christiaens M-R, Neven P, Geraerts I, Struyf F, Devoogdt N. Inter-rater reliability of shoulder measurements in middle-aged women. Physiotherapy. 2017;103(2):222–30; doi: 10.1016/j.physio.2016.07.002.
20.
Panicek DM, Benson CB, Gottlieb RH, Heitzman ER. The diaphragm: anatomic, pathologic, and radiologic considerations. Radiographics. 1988;8(3):385–425; doi: 10.1148/radiographics.8.3.3289099.
21.
Andrade LS, Jaison J, B J, Lewis CR, Prasanna LC. A study on the variants of phrenic nerve roots with histological correlation. Transl Res Anat. 2021;23:100123; doi:10.1016/j.tria.2021.100123.
22.
Chen B, Liu L, Chen LB, Cao X, Han P, Wang C, Qi Q. Concurrent validity and reliability of a handheld dynamometer in measuring isometric shoulder rotational strength. J Sport Rehabil. 2020;30(6): 965–68; doi: 10.1123/jsr.2020-0021.
23.
Horsley I, Herrington L, Hoyle R, Prescott E, Bellamy N. Do changes in hand grip strength correlate with shoulder rotator cuff function?. Shoulder Elbow. 2016;8(2):124–9; doi: 10.1177/1758573215626103.
24.
Douma RK, Soer R, Krijnen WP, Reneman M, van der Schans CP. Reference values for isometric muscle force among workers for the Netherlands: a comparison of reference values. BMC Sports Sci Med Rehabil. 2014;6(1):10; doi: 10.1186/2052-1847-6-10.
25.
Alotaibi NM. Cross-cultural adaptation process and pilot testing of the Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-Arabic). Hand Ther. 2010;15(4):80–6; doi: 10.1258/ht.2010.010021.
26.
Alotaibi NM, Aljadi SH, Alrowayeh HN. Reliability, validity and responsiveness of the Arabic version of the Disability of Arm, Shoulder and Hand (DASH-Arabic). Disabil Rehabil. 2016;38(25):2469–78; doi: 10.3109/09638288.2015.1136846.
27.
Rikli RE, Jones CJ. The reliability and validity of a 6-Minute Walk Test as a measure of physical endurance in older adults. J Aging Phys Act. 1998;6(4):363–75; doi: 10.1123/japa.6.4.363.
28.
Whittaker D. Multidisciplinary approaches to breathing pattern disorders. Australas Chiropr Osteopathy. 2002;10(2):111.
29.
Ward RC. Foundations for Osteopathic Medicine. Philadelphia: Lippincott Williams and Wilkins; 2003.
30.
Ricard F, Salle J-L. Osteopathy Treatise [in Spanish]. 3rd ed. Medica Panamericana; 2003.
31.
Akbaba YA, Mutlu EK, Altun S, Turkmen E, Birinci T, Celik D. The effectiveness of trigger point treatment in rotator cuff pathology: a randomized controlled double- -blind study. J Back Musculoskelet Rehabil. 2019;32(3):519–27; doi: 10.3233/BMR-181306.
32.
Cunningham G, Charbonnier C, Lädermann A, Chagué S, Sonnabend DH. Shoulder motion analysis during codman pendulum exercises. Arthrosc Sports Med Rehabil. 2020;2(4):e333–9; doi: 10.1016/j.asmr.2020.04.013.
33.
Tanaka K, Saura R, Takahashi N, Hiura Y, Hashimoto R. Joint mobilization versus self-exercises for limited glenohumeral joint mobility: randomized controlled study of management of rehabilitation. Clin Rheumatol. 2010;29(12):1439–44; doi: 10.1007/s10067-010-1525-0.
34.
Şahin O, Kocamaz D. Effects of diaphragmatic mobilization and diaphragmatic breathing exercises on pain and quality of life in individuals with shoulder pain: a randomized controlled trial. Int J Disabil Sports Health Sci. 2021;4(2):113–23; doi: 10.33438/ijdshs.976285.
35.
Karkousha RN, Yousef JE, Abdel Raoof NA, Grase MO. Effect of Pilates exercise on balance and spinal curvature in subjects with upper cross syndrome: a randomized controlled clinical trial. Physiother Quart. 2024;32(3):90–7; doi: 10.5114/pq.2024.130504.
36.
Elhafez HM, Mohammed KS, Alshaymaa S. Abd El-Azeim, Abdallah GA. Pilates mat versus cervical stabilization exercises on the craniovertebral angle, pain, function, and myoelectrical activity of the cervical muscles in forward head posture: a randomized controlled trial. Physiother Quart. 2024;32(3):63–73; doi: 10.5114/pq/175217.
37.
Kolomiitseva O, Prikhodko A, Bodrenkova I, Hrynchenko I, Vashchenko I, Honchar R. Effect of Pilates training on respiration, joints mobility, and muscle strength in healthy middle-aged women with sedentary occupations. Acta Gymn. 2022;52:e2022.008; doi:10.5507/ag.2022.008.
38.
Keays KS, Harris SR, Lucyshyn JM, MacIntyre DL. Effects of Pilates exercises on shoulder range of motion, pain, mood, and upper-extremity function in women living with breast cancer: a pilot study. Phys Ther. 2008;88(4):494–510; doi: 10.2522/ptj.20070099.
39.
Mohamed YH, Ali KM, Mohamed AE, Aboelnour NH, Ashem HN. Effect of Pilates exercises on muscle strength and balance after healed lower limb burns. Adv Rehabil. 2024;38(4):34–44; doi:10.5114/areh.2024.144868.
40.
Guclu-Gunduz A, Yazici G, Ozkul C, Bulguroglu HI, Irkec C. The effects of pilates on functional exercise capacity in patients with multiple sclerosis. J Neurol Sci. 2017;381:598; doi: 10.1080/09638288.2023.2205174.
41.
Rocha T, Souza H, Brandão DC, Rattes C, Ribeiro L, Campos SL, Aliverti A, de Andrade AD. The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial. J Physiother. 2015;61(4):182–9; doi: 10.1016/j.jphys.2015.08.009.
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
