The Role of Posterior Shoulder Tightness in Rotator Cuff Related Shoulder Pain

  • Kevin Hall

Student thesis: Doctoral Thesis


The primary aim of this Thesis was to design and conduct a randomised controlled feasibility pilot trial to evaluate the effect of treating posterior shoulder tightness on pain and disability in individuals with rotator cuff related shoulder pain (RCRSP). The Posterior Shoulder Tightness (PoST) feasibility pilot trial was informed by patient and public involvement in the design stage and during implementation. This involvement was particularly influential in the development of PoST feasibility pilot trial behaviour change interventions, and was the impetus for the development of the systematic review and qualitative study research questions. The Thesis was underpinned by a pragmatist philosophical stance.

The PoST feasibility pilot trial (N=49) was successful in addressing all the primary feasibility objectives. Interventions were deemed safe and acceptable and generated large within group changes in patient reported outcome measures and measures of posterior shoulder tightness in both groups. The results of this pilot trial suggest that a full scale definitive RCT is not viable under the pilot study conditions due to the predicted recruitment rate and recruitment target. It would be possible to generate faster recruitment through the addition of more centres, however the trial would need to be piloted at these centres first.

Findings from the systematic review suggest poor reporting of adherence and the under-utilisation of behaviour change interventions to promote home exercise adherence was prevalent in the 17 included randomised controlled trials. Many authors either failed to report home exercise adherence, or reported poor or unknown adherence. Understanding home exercise adherence is important in order to determine the efficacy of home exercise in the management of RCRSP.

Findings from the qualitative study suggest that understanding the beliefs of persons receiving care is important in order to guide treatment and to enable physiotherapists to individualise care. The relationship with the physiotherapist may be an important aspect of the therapeutic interaction influencing exercise adherence. Individuals wanted a physiotherapist they felt at comfortable with and trusted; they wanted reassurance that they were performing their exercises correctly.

All objectives of the Thesis were met and the contribution to new knowledge discussed.
Date of Award2022
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorColette Ridehalgh (Supervisor), Dr Jeremy Lewis (Supervisor), Ann Moore (Supervisor) & Chris Cocking (Supervisor)

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