Exercise Professional Education

06/02/2026

Effects of seven types of exercise in the treatment of rotator cuff-related shoulder pain (RCRSP): a systematic review and Bayesian network meta-analysis

"Abstract
Background
Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain and represents one of the most common musculoskeletal conditions affecting the shoulder. Despite ample evidence supporting the effectiveness of exercise therapy for RCRSP, no consensus exists regarding the optimal exercise intervention. This systematic review aims to evaluate and compare the efficacy of specific versus conventional exercise interventions for improving pain and dysfunction in patients with RCRSP.

Methods
The MEDLINE, Embase, Cochrane Library, CINAHL, SPORTiscus, and Web of Science databases were searched up to June 2025. Randomized controlled trials that diagnosed with RCRSP or a synonymous condition (e.g., rotator cuff tendinopathy, subacromial impingement, subacromial pain syndrome, subacromial bursitis, long-head biceps tendinopathy, or partial-thickness rotator cuff tear) were included, comparing at least two different types of exercise interventions and reporting on the effects associated with pain, dysfunction, related self-reported outcome metrics. A Bayesian network meta-analysis (NMA) was performed to compare seven exercise interventions, with
treatments ranked using the surface under the cumulative ranking curve (SUCRA).

Results
The Shoulder Pain Score Analysis Network contained 15 studies (n=913; 45% female); the Shoulder Dysfunction Index Analysis Network contained 16 studies (n=947; 47% female). In terms of shoulder dysfunction improvement, concentric strengthening training (CST) demonstrated a significant advantage in most comparisons and was identified as the most effective exercise intervention program for the treatment of RCRSP, eccentric
strengthening training (ECT) and traditional training (TT) were moderately effective, and significantly superior
o motor control exercise (MCE) and scapula-focused training (SFT). HLT, which had negative effect sizes in most
comparisons, appeared to be the worst exercise intervention program. In terms of shoulder pain improvement, CST"

Zhang et al. Journal of Orthopaedic Surgery and Research (2025) 20:1075

Background Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain and represents one of the most common musculoskeletal conditions affecting the shoulder. Despite ample evidence supporting the effectiveness of exercise therapy for RCRSP, no consensus exists regarding th...

05/26/2026

Paradoxes weaken the International Association for the Study of Pain definition of pain

"A compound paradox has been identified in the revised (2020) International Association for the Study of Pain (IASP) definition of pain, such that it simultaneously prescribes a connection between pain and tissue damage and allows that prescription to be violated. In a narrative form, the objective of this paper is to reveal these paradoxes and to offer a pathway to their resolution, thus clarifying the definition of pain for the purposes of scientific study and clinical application. The first paradox is that contradictory true positions can be held, when the experiencer claims to be “in pain” and the observer cannot find the required association with tissue damage or, preferably as is argued, nociception. The second paradox is revealed by the construct of “nociplastic” pain, which contradicts the IASP definition to the extent that nociceptors have not been activated, yet at the same time is consistent with that definition to the extent that it “resembles” an experience associated with actual or potential tissue damage. In the interests of all concerned parties, the IASP definition of pain can be strengthened by removing the current ambiguity of interpretation, grounding the experience in a reconceptualisation of nociception as activation of a nociceptive apparatus, and clearly distinguishing it from suffering."

Korean J Pain 2026;39(1):51-58 https://doi.org/10.3344/kjp.25268 pISSN 2005-9159, eISSN 2093-0569

Milton L. Cohen, Asaf Weisman, and John L. Quintner. Korean J Pain 2026;39:51-8. https://doi.org/10.3344/kjp.25268

05/19/2026

Recommended Reading:

The Multimodal Assessment Model of Pain
A Novel Framework for Further Integrating the Subjective Pain
Experience Within Research and Practice

"Objectives:
Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this problem, such as what essential aspects of pain are overlooked when we only rely on numeric forms of assessment, and what types of assessment need to be prioritized to ensure alignment with our conceptualization of pain as a subjective experience. We present the multimodal assessment model of pain (MAP) as offering practical frameworks for navigating these challenges.

Methods:
This is a narrative review.

Results:
MAP delineates qualitative (words, behaviors) and quantitative (self-reported measures, non–self-reported measures) assessment and regards the qualitative pain narrative as the best available root proxy for inferring pain in others. MAP offers frameworks to better address pain subjectivity by: (1) delineating separate criteria for identifying versus assessing pain. Pain is identified through narrative reports, while comprehensive assessment is used to infer why pain is reported; (2) integrating compassion-based and mechanism-based management by both validating pain reports and assessing underlying processes; (3) conceptualizing comprehensive pain assessment as both
multidimensional and multimodal (listening/observing and measuring); and (4) describing how qualitative data help validate and contextualize quantitative pain measures.

Discussion:
MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain."

Wideman TH, Edwards RR, Walton DM, Martel MO, Hudon A, Seminowicz DA. The Multimodal Assessment Model of Pain: A Novel Framework for Further Integrating the Subjective Pain Experience Within Research and Practice. Clin J Pain. 2019 Mar;35(3):212-221. doi: 10.1097/AJP.0000000000000670. PMID: 30444733; PMCID: PMC6382036.

05/12/2026

Wow this would make learning and growing very, very difficult …

05/05/2026

The Health and Functional Benefits of Eccentric versus Concentric Exercise Training: A Systematic Review and Meta-Analysis

"Abstract
This review compared the effects of eccentric versus concentric
exercise training in healthy people and people with metabolic disease. A systematic search on Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, SPORTDiscus,
Web of Science, SCOPUS and PubMed was conducted in February 2022. Randomised controlled trials conducted on sedentary healthy adults or those with an existing metabolic disease that compared eccentric versus concentric exercise training interventions of four weeks or longer that involved multiple joints and large muscle groups (e.g., walking, whole-body resistance training) were included in the review. The primary outcome was glucose handling, measured as HbA1c, HOMA, fasting glucose or insulin. Measures of cardiovascular health, muscle strength, and functional physical fitness were secondary outcomes. Nineteen trials involving 618 people were included. Results of meta-analyses showed that eccentric exercise had no benefit to glucose handling (HbA1c level; SMD - 0.99; 95% CI, -2.96 to 0.98; n = 74; P = 0.32) but resulted in significant increases in overall muscle strength (SMD 0.70; 95% CI 0.25 to 1.15; n = 224; P = 0.003) and decreases in blood pressure (Systolic Blood Pressure; MD - 6.84; 95% CI, -9.84 to -3.84; n = 47, P = 0.00001, and Diastolic Blood Pressure; MD -6.39; 95% CI -9.62 to -3.15; n = 47, P = 0.0001). Eccentric exercise is effective for improving strength and some markers of cardiovascular health compared to traditional exercise modalities. Additional high-quality studies are necessary to validate these results. (PROSPERO registration: CRD42021232167)."

Ansari M, Hardcastle S, Myers S, Williams AD. The Health and Functional Benefits of Eccentric versus Concentric Exercise Training: A Systematic Review and Meta-Analysis. J Sports Sci Med. 2023 Jun 1;22(2):288-309. doi: 10.52082/jssm.2023.288. PMID: 37293426; PMCID: PMC10244982.

04/28/2026

Altered energy dissipation patterns and increased ground reaction force in patients with chronic ankle instability after fatiguing exercises

"Abstract
The purpose of this study was to investigate whether the interaction between chronic ankle instability (CAI) and fatigue alters energy absorption strategies and ground reaction force (GRF) during landing. This cross-sectional study was conducted in a laboratory setting and included 20 patients with CAI, 20 copers, and 20 healthy controls. All participants performed single-leg drop landing before and after the fatigue protocol. The fatigue protocol consisted of repeated cycles of multidirectional running, hopping, and jumping tasks. Heart rate (HR) and rated perceived exertion (RPE) were monitored after each cycle, and the protocol was repeated until participants reached ≥ 85% of maximal heart rate and RPE ≥ 17. Lower-extremity angles and power, relative joint contribution to shock absorption, and GRF were measured from initial foot contact to 200 ms after landing. The interaction effect of group and fatigue was analyzed using functional ANOVA and two-way repeated measures ANOVA. Interaction effects showed that after fatiguing exercises, patients with CAI exhibited (1) less sagittal hip excursion, (2) more eccentric power patterns in the hip and knee joints, (3) a greater contribution of the hip and knee to total lower-extremity energy dissipation, and (4) greater vertical GRF during the initial phase of landing compared to copers and/or controls. Under fatigue, patients with CAI demonstrated altered proximal kinetic strategies with greater GRF. Despite these adaptations, patients with CAI exhibited higher GRF after fatigue. This highlights the need for interventions aimed at optimizing neuromuscular control to more efficiently distribute impact forces across the lower-extremity."

Hyung Gyu Jeon, Tae Kyu Kang, Hyunsoo Kim, Kyeongtak Song, Sae Yong Lee, Altered energy dissipation patterns and increased ground reaction force in patients with chronic ankle instability after fatiguing exercises, Journal of Biomechanics, 2026,
113289, ISSN 0021-9290, https://doi.org/10.1016/j.jbiomech.2026.113289.

04/21/2026

The pathogenesis of tendinopathy: balancing the response to loading

"Abstract
Tendons are designed to withstand considerable loads. Mechanical loading of tendon tissue results in upregulation of collagen expression and increased synthesis of collagen protein, the extent of which is probably regulated by the strain experienced by the resident fibroblasts (tenocytes). This increase in collagen formation peaks around 24 h after exercise and remains elevated for about 3 days. The degradation of collagen proteins also rises after exercise, but seems to peak earlier than the synthesis. Despite the ability of tendons to adapt to loading, repetitive use often results in injuries, such as tendinopathy, which is characterized by pain during activity, localized tenderness upon palpation, swelling and impaired performance. Tendon histological changes include reduced numbers and rounding of fibroblasts, increased content of proteoglycans, glycosaminoglycans and water, hypervascularization and disorganized collagen fibrils. At the molecular level, the levels of messenger RNA for type I and III collagens, proteoglycans, angiogenic factors, stress and regenerative proteins and proteolytic enzymes are increased. Tendon microrupture and material fatigue have been suggested as possible injury mechanisms, thus implying that one or more 'weak links' are present in the structure. Understanding how tendon tissue adapts to mechanical loading will help to unravel the pathogenesis of tendinopathy."

Key Points
• Tendons are metabolically active and respond readily to both loading and unloading
• Mechanical loading results both in protein synthesis and degradation of collagen
• Without sufficient rest (24 h) after exercise, net loss of collagen might occur that leaves the tendon vulnerable to injury
• Tendinopathy is associated with neovascularization, but newly formed blood vessels (and nerves) disappear during healing
• The pathogenesis of tendinopathy can be accelerated by overloading

Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010 May;6(5):262-8. doi: 10.1038/nrrheum.2010.43. Epub 2010 Mar 23. PMID: 20308995.

09 April 2010
In the version of this article initially published online, the tendon in Figure 1 was indicated as being 0.5–1.0mm2 instead of 0.5–1.0cm2. In addition, the measurements relating to the collagen fascicle, fibril and molecule in Figure 1 should all refer to the diameter of these entities. These errors have been corrected in all versions of the article.

04/15/2026

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04/14/2026

Intra-articular remodeling of hamstring tendon grafts after anterior cruciate ligament reconstruction

Abstract

Purpose
A summary is provided on the existing knowledge about the specific healing phases of the intra-articular hamstring tendon graft used for ACL reconstruction. Differences between human and animal in vivo studies are explained, and implications for the postoperative time period are laid out.

Methods
A systematic review of the existing literature was performed on the topic of tendon remodelling of hamstring grafts in ACL reconstruction using Medline database. Publications between 1982 and 2012 were included. Special focus was directed on in vivo human and animal studies analysing intra-articular free tendon graft remodelling.

Results
Animal and human in vitro and vivo researches have demonstrated three characteristic stages of graft healing after ACL reconstruction: an early graft healing phase with central graft necrosis and hypocellularity and no detectable revascularization of the graft tissue, followed by a phase of proliferation, the time of most intensive remodelling and revascularization and finally, a ligamentization phase with characteristic restructuring of the graft towards the properties of the intact ACL. However, a full restoration of either the biological or biomechanical properties of the intact ACL is not achieved.

Conclusion
Significant knowledge on human cruciate ligament remodelling has been added in the understanding of the processes during the course of graft healing. Most importantly, the remodelling process in humans is prolonged compared to animal studies. While today's rehabilitation protocols are often extrapolated from findings of animal in vivo healing studies, current findings of human in vivo healing studies might require new post-operative regimens following hamstring ACL reconstruction.

Janssen RP, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2102-8. doi: 10.1007/s00167-013-2634-5. Epub 2013 Aug 27. PMID: 23982759; PMCID: PMC4142140.

04/07/2026

Wearing a knee brace or ankle brace... so what... right?

"Abstract
This paper extends an initial investigation and
application of gait asymmetry using wireless gyroscope,
normalized Symmetry Index (SInorm), and normalized crosscorrelation (Ccnorm). In this study, one side of the participant’s lower exteremity movement is restricted using knee brace or ankle brace. Wireless gyroscopes are then attached to
participant’s left thigh, left shank, right thigh and right shank.
Measurement data are collected for duration of one minute while
participant is walking on a treadmill. The experimental results
are satisfactory. Significant asymmetric gait was observed when
the participant walks with knee brace or ankle brace on one side
of the limbs. The knee brace produced greater asymmetry than
ankle brace. These were apparent in both SInorm and Ccnorm."

"VIII. CONCLUSION
Gait asymmetry is one of the crucial parameters in gait
analysis. It defines the coordination of the left limb and right
limb in providing support and propulsion during walking. Gait
of healthy individual is fairly symmetrical with acceptable
deviations. This study supports the application of SInorm and
Ccnorm in identifying gait asymmetry in normal gait and
abnormal gait generated by restricting knee or ankle
movement. SInorm was found to behave differently when the
participants walked with knee brace or ankle brace. Significant
difference in Ccnorm was also observed with p < 0.01."

D. Gouwanda, "Further validation of Normalized Symmetry Index and normalized cross-correlation in identifying gait asymmetry on restricted knee and ankle movement," 2012 IEEE-EMBS Conference on Biomedical Engineering and Sciences, Langkawi, Malaysia, 2012, pp. 423-427, doi: 10.1109/IECBES.2012.6498167.