Mode
Text Size
Log in / Sign up

Shoulder Strength Gains Show Limited Association With Function and Pain in HSDDoes building shoulder strength actually help pain and function in hypermobility?

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Interpret shoulder strength gains in HSD as weakly associated with function and pain; clinical relevance appears limited.

This is a secondary analysis of a randomised controlled trial evaluating whether changes in shoulder strength are associated with self-reported shoulder function, pain, and perceived effect in patients with Hypermobility Spectrum Disorder (HSD) and shoulder symptoms. Treatment standardisation for HSD is lacking and the relationship between strength and symptoms has remained unclear.

Data from 76 participants (58 women; median age 35.5) were included. Primary outcomes were percentage change in relative strength (Nm/kg) in external rotation, internal rotation, and scaption, along with the Western Ontario Shoulder Instability Index (WOSI), the Numerical Pain Rating Scale (NPRS), and the Global Perceived Effect: Physical domain (GPEP). Secondary outcomes included achievement of the Minimal Clinically Important Difference (MCID) in function and pain. Covariates included age, sex, BMI, hand dominance, previous shoulder dislocation, mechanical symptoms, and assigned intervention group.

Increases in external rotation and scaption strength were linearly associated with improvement in shoulder function (adjusted WOSI -3.5, 95% CI -5.9 to -1.1; and -2.6, 95% CI -4.6 to -0.6, respectively). Scaption strength was associated with a reduction in shoulder pain (NPRS -0.01, 95% CI -0.02 to 0.00). For every 10% increase in strength, the adjusted odds of reporting an important improvement were 1.18 (95% CI 1.00 to 1.38) for external rotation and 1.30 (95% CI 1.07 to 1.59) for scaption.

Safety data and follow-up duration were not reported in the abstract. Because this is a secondary analysis investigating associations rather than causation, and the authors explicitly describe the findings as of limited clinical relevance, inferences about clinical impact should be restrained. Further research is needed to clarify the relationship between strength gains and symptom relief in HSD.

Imagine living with a shoulder that feels unstable and hurts. For people with Hypermobility Spectrum Disorder, this is a daily reality. A recent look at a previous study examined whether exercising to build strength in specific shoulder movements could help. The group involved 76 participants, mostly women in their mid-30s, who tried high-load or low-load exercise routines for 16 weeks.

The analysis found that improving strength in turning the arm outward and lifting it to the side was connected to better shoulder function and lower pain scores. For every 10% increase in strength, the odds of reporting a meaningful improvement went up. No serious safety issues were reported during the trial.

Yet, there is a catch. The researchers noted that these findings might have limited relevance for real-world clinical practice. The link between strength gains and symptom relief is not fully understood yet. Because this was a secondary analysis of an existing trial, we cannot say for sure that the exercise caused the improvement. Further research is needed to confirm if this approach truly helps patients.

What this means for you:
Stronger shoulders linked to less pain, but limited clinical relevance remains.

Study Details

Study typeRct
Sample sizen = 76
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
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).
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.