TY - JOUR
T1 - Association Between Changes in Shoulder Strength and Self-Reported Shoulder Symptoms in Patients With Hypermobility Following 16-Weeks of High-Load or Low-Load Exercise
T2 - A Secondary Analysis of an RCT
AU - Christensen, Thomas
AU - Juhl, Carsten Bogh
AU - Juul-Kristensen, Birgit
AU - Skou, Søren T
AU - Søndergaard, Jens
AU - Søgaard, Karen
AU - Liaghat, Behnam
N1 - © 2026 The Author(s). Physiotherapy Research International published by John Wiley & Sons Ltd.
PY - 2026/4
Y1 - 2026/4
N2 - BACKGROUND AND PURPOSE: Hypermobility Spectrum Disorder (HSD) is a common musculoskeletal condition that impairs function and quality of life. While exercise therapy has shown to improve outcomes, treatment standardisation is lacking and the relationship between strength and symptoms remains unclear. Therefore, our aim was to investigate the association between changes in shoulder strength and self-reported shoulder function, pain, and perceived effect in patients with HSD and shoulder symptoms.METHODS: This is a secondary analysis of a randomised controlled trial. Data from 76 participants (58 women; median age 35.5) were included. Primary outcomes were percentage change in relative strength (Nm/kg) measured in external rotation, internal rotation, and scaption, the Western Ontario Shoulder Instability Index (WOSI), the Numerical Pain Rating Scale (NPRS) and the Global Perceived Effect: Physical domain (GPEP). Secondary outcomes were achieving the Minimal Clinically Important Difference (MCID) in shoulder function and pain. Covariates were age, sex, Body Mass Index, hand dominance, previous shoulder dislocation, mechanical shoulder symptoms, and assigned intervention group.RESULTS: Increasing strength in external rotation and scaption were linearly associated with an improvement in shoulder function (WOSI adjusted -3.5 (95% CI -5.9; -1.1), and WOSI adjusted -2.6 (95% CI -4.6; -0.6) respectively), while scaption strength was associated with a reduction in shoulder pain (NPRS -0.01 (95% CI -0.02; 0.00)). Improvement in external rotation and scaption were associated with higher odds of reporting an important improvement measured for every 10% increase in strength (adjusted OR 1.18 (95% CI 1.00; 1.38) and 1.30 (95% CI 1.07; 1.59), respectively).DISCUSSION: Increased shoulder strength may be associated with improved outcomes in patients with HSD and persistent shoulder symptoms although our findings suggest limited clinical relevance. Further research is needed to understand the relationship between strength and symptom relief.TRIAL REGISTRATION: The study was registered in Clinicaltrials.gov (11 March 2019, NCT03869307).
AB - BACKGROUND AND PURPOSE: Hypermobility Spectrum Disorder (HSD) is a common musculoskeletal condition that impairs function and quality of life. While exercise therapy has shown to improve outcomes, treatment standardisation is lacking and the relationship between strength and symptoms remains unclear. Therefore, our aim was to investigate the association between changes in shoulder strength and self-reported shoulder function, pain, and perceived effect in patients with HSD and shoulder symptoms.METHODS: This is a secondary analysis of a randomised controlled trial. Data from 76 participants (58 women; median age 35.5) were included. Primary outcomes were percentage change in relative strength (Nm/kg) measured in external rotation, internal rotation, and scaption, the Western Ontario Shoulder Instability Index (WOSI), the Numerical Pain Rating Scale (NPRS) and the Global Perceived Effect: Physical domain (GPEP). Secondary outcomes were achieving the Minimal Clinically Important Difference (MCID) in shoulder function and pain. Covariates were age, sex, Body Mass Index, hand dominance, previous shoulder dislocation, mechanical shoulder symptoms, and assigned intervention group.RESULTS: Increasing strength in external rotation and scaption were linearly associated with an improvement in shoulder function (WOSI adjusted -3.5 (95% CI -5.9; -1.1), and WOSI adjusted -2.6 (95% CI -4.6; -0.6) respectively), while scaption strength was associated with a reduction in shoulder pain (NPRS -0.01 (95% CI -0.02; 0.00)). Improvement in external rotation and scaption were associated with higher odds of reporting an important improvement measured for every 10% increase in strength (adjusted OR 1.18 (95% CI 1.00; 1.38) and 1.30 (95% CI 1.07; 1.59), respectively).DISCUSSION: Increased shoulder strength may be associated with improved outcomes in patients with HSD and persistent shoulder symptoms although our findings suggest limited clinical relevance. Further research is needed to understand the relationship between strength and symptom relief.TRIAL REGISTRATION: The study was registered in Clinicaltrials.gov (11 March 2019, NCT03869307).
KW - Humans
KW - Female
KW - Male
KW - Adult
KW - Joint Instability/physiopathology
KW - Self Report
KW - Exercise Therapy/methods
KW - Muscle Strength/physiology
KW - Middle Aged
KW - Shoulder Joint/physiopathology
KW - Shoulder Pain/physiopathology
KW - Range of Motion, Articular/physiology
KW - Pain Measurement
KW - Treatment Outcome
KW - Young Adult
KW - Joint instability
KW - Resistance training
KW - Shoulder
KW - Randomised controlled trial
U2 - 10.1002/pri.70197
DO - 10.1002/pri.70197
M3 - Article
C2 - 41848184
SN - 1358-2267
VL - 31
JO - Physiotherapy Research International
JF - Physiotherapy Research International
IS - 2
M1 - e70197
ER -