Effect of Pilates exercises and diaphragm manual therapy techniques in rotator cuff tendinopathy

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.