EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION COMBINED WITH PHYSICAL EXERCISE ON PAIN, PHYSICAL FUNCTION AND QUALITY OF LIFE IN INDIVIDUALS WITH CHRONIC SHOULDER TENDINOPATHY: A RANDOMIZED CLINICAL TRIAL.
Rotator Cuff. Chronic Pain. Transcranial Direct Current Stimulation.
Introduction: Pain is one of the main symptoms that affect people with chronic shoulder tendinopathy. Physical exercise is the primary approach to managing this symptom, which aims to restore movement patterns, improve scapular kinematics, and provide greater local muscle strength and endurance. Pain neuromodulation techniques such as Transcranial Direct Current Stimulation (tDCS) may constitute complementary non-pharmacological options to promote pain relief, based on central modulation and changes in cortical excitability. Objective: To evaluate the effects of tDCS combined with a protocol of specific shoulder exercises in individuals with chronic shoulder tendinopathy. Methods: This is a randomized, triple-blind clinical trial. It was approved by the ethics and research committee (opinion number: 6,821,408). They were divided into two groups: active tDCS combined with physical exercises (G1) and Sham tDCS combined with physical exercises (G2). The interventions occurred over 4 weeks, with two sessions per week, on non-consecutive days. The following stages were evaluated: primary (pain) and secondary (disability, physical function, adherence and global perception of change). The evaluations occurred at three moments: Before, after and seven days after the disciplines. Results: Forty individuals aged 44.75±12.95 years participated in the study. A significant difference and a clinically important change in pain were found between the others at T1 (p=0.001) and T2 (p=0.001), in G1. A significant difference in disability was seen at T1 (p=0.003) and T2 (p=0.001), as well as an important clinical change at T2 in the individuals in group G1. Regarding the global perception of change, a significant difference (U=132; p=0.018) was detected between the medians when comparing G1 and G2 (sums of the scores=478 and 342, respectively). When comparing the percentage of adherence to the protocol of both groups, there was no difference between them (p=0.05). Conclusion: We can conclude from this study that the use of tDCS combined with a specific exercise protocol added positive effects on pain, disability and global perception of change in individuals with chronic shoulder tendinopathy.