28 (link)
29 (link) and clinical experience and focused on strengthening eccentric exercises for the rotator cuff and strengthening concentric/eccentric exercises for the scapula stabilisers. The programme consisted of six different exercises: two eccentric exercises for the rotator cuff (supraspinatus, infraspinatus, and teres minor), three concentric/eccentric exercises for the scapula stabilisers (middle and lower trapezius, rhomboideus, and serratus anterior), and a posterior shoulder stretch. Each strengthening exercise was repeated 15 times in three sets twice daily for eight weeks. The posterior shoulder stretch was performed for 30-60 seconds and repeated three times twice daily. From week eight to week 12, the exercises were repeated once a day. The exercises were individually adjusted and progressed with increased external load by using weights and elastic rubber band at the physiotherapist visits once every other week during the whole rehabilitation period. When necessary, the physiotherapist performed manual treatment by stretching the posterior glenohumeral capsule and pectoralis minor during the visits. The pain monitoring model30 (link) was used to find the individual resistance for each patient. The patients were not allowed to exceed 5 on this 0-10 scale when they performed the exercises; however, they were recommended to feel some pain during loading. After completion of an exercise session, increased pain had to revert to levels before exercise before the next session; otherwise, the external load was decreased. Great emphasis was placed on teaching good posture (thoracic spine extension and retracted shoulders) and to maintain this position during the exercises. After completion of the specific exercise programme (after 12 weeks), we recommended participants to maintain the daily home exercises for another two months. A more detailed description of the exercise programme can be found in the appendix on bmj.com.