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Fysio Online! De toekomst
voor mensen met secundaire
impingement klachten.
Isabelle Joosten & Vincent van Meeteren
•Fysio Online – schouder -‘inklemming’ • schouderinklemming = impingement
• Adviezen • Voorkomen overbelasting
• Warmte-/Koudepakking
• Massage
Welk effect heeft oefentherapie bij volwassenen
tussen de 18 en 65 jaar met secundaire impingement
klachten, met als onderliggende pathologische
mechanismen scapulaire dysfunctie, biceps-SLAP en
GIRD, gericht op pijnvermindering en
functieverbetering?
• Primair impingement • Structurele verandering
• Vernauwing van subacromiale ruimte
• Secundair impingement • Functionele verandering
• Beknelling in subacromiale ruimte of in art. humeri
• Oorzaak: Verschillende pathologische mechanismen
Cools AM, Cambier D, Witvrouw EE. Screening the athlete’s shoulder for impingement symptoms: a clinical
reasoning algorithm for early detection of shoulder impingement symptoms: a clinical reasoning. Med 2008 42:
628-635
• Gebruikte databases • Pubmed, Cochrane Library, PEDro
• Selectieprocedure
• Uitkomstmaten • Pijn & Schouderfunctie
• Kwaliteitscontrole • Critical Appraised Topic (CAT) analyse
• Type impingement • primair t.o.v. secundair
• Soorten studies • 12 artikelen
• 5 RCTs, 2 randomized trials, 2 cohort studies, 2 single-
subject study designs, 2 case series en 1 pilot study
• CAT scores • 6 voldoende (≥60 punten)
Resultaten oefenvormen
Pijn Functie
Rek- en kracht n = 2 11,5 % 13 %
Kracht n = 4 24 % 23,5 %
Excentrisch n = 2 30 % 21,5 %
Zelftraining n = 3 13,5 % 10 %
Intensiteit n = 1 37 % (17 %) 31 % (22 %)
• Fysio Online vs Literatuur
• Fysio Online vrij globale beschrijving
• Oefentherapie
• Warmte-/Koudepakking (i.c.m. oefentherapie)
Maar…
• Oefentherapie vrij globaal
• Oefeningen mogen pijn doen
• Primair – Secundair
• Ontstaanswijze
• Aanbevelingen:
• Onderscheid in Primair en Secundair impingement
• Excentrische oefeningen toevoegen
• Moet pijnlijk zijn
• Verhoogde trainingsintensiteit
• Verder onderzoek naar warmte-/koudepakking en massage
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•Cools AM, Cambier D, Witvrouw EE. Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning
algorithm for early detection of shoulder impingement symptoms: a clinical reasoning. Med 2008 42: 628-635
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