Should Exercises be Painful or not? Effects on Clinical and Experimental Pain in Individuals with Shoulder Pain

  • M Balasch-Bernat
    Department of Physiotherapy, University of Valencia, Spain

    Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain
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  • E Lluch
    Address reprint requests to Enrique Lluch, PT, PhD., Department of Physiotherapy, University of Valencia, Gascó Oliag 5, Valencia.
    Department of Physiotherapy, University of Valencia, Spain

    Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain

    Departments of Human Physiology and Rehabilitation Sciences, “Pain in Motion” International Research Group, Brussels, Belgium
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  • HB Vaegter
    Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark

    Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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  • L Dueñas
    Department of Physiotherapy, University of Valencia, Spain

    Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain
    Search for articles by this author


      • Painful and nonpainful exercises cause a short-lasting increase in shoulder pain
      • Painful isometric exercises evoke no more postexercise pain than pain-free isometric exercises
      • No isometric exercise modality influence shoulder pain sensitivity, strength, or conditioned pain modulation


      Exercise can reduce pain, however the effect of painful versus non-painful exercises is uncertain. The primary aim of this randomized crossover study was to compare the effect of painful versus nonpainful isometric shoulder exercises on pain intensity after exercise in individuals with rotator cuff-related shoulder pain. Secondary exploratory aims were to describe the effects on pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and muscle strength. On separate days, 35 individuals performed painful isometric shoulder exercises (external rotation; 20% above pain threshold), nonpainful isometric shoulder exercises (external rotation; 20% below pain threshold), and a rest condition, in randomised order. Shoulder pain intensity, PPTs, CPM, and external rotation strength were assessed before, immediately after and 45 minutes after conditions. No significant differences were observed between painful and nonpainful exercises. Visual analogue scale scores increased immediately after both painful and non-painful exercises compared with rest (P = .047, partial ƞ2 = .07), but were similar to preexercise levels after 45 minutes. No changes in PPTs, CPM, or muscle strength after exercises compared with rest were observed. Painful and non-painful isometric exercises caused a moderate but short-lasting increase in shoulder pain in individuals with RCRSP. Isometric exercises had no effect on pain sensitivity and shoulder muscle strength or CPM.


      This study evaluated for the first time in individuals with rotator cuff-related shoulder pain the effects of painful versus non-painful isometric exercises on different pain-related outcome measures. Both painful and non-painful isometric exercises caused a moderate but relatively short-lasting increase in shoulder pain in individuals with rotator cuff-related shoulder pain.
      Trial registration number: ( NCT03675399

      Key words

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