Background: Exercise therapy is essential in managing rotator cuff-related shoulder pain. Multimedia tools may enhance adherence and engagement, but their added value over traditional materials remains uncertain. Objective: To compare an exercise program delivered through paper-based materials with or without addition of multimedia animations in individuals with rotator cuff-related shoulder pain. Method: A single-center open-label randomized clinical trial was conducted in [Blinded] between April 2023 and December 2024 Patients with rotator cuff-related shoulder pain were included. Both groups received seven face-to-face exercise sessions with a physical therapist and were randomized into receiving or not multimedia animations. The main outcome measure was Shoulder Pain and Disability Index at 6-week follow-up. Other outcomes were pain intensity (rest, during movement and at night), patients’ satisfaction, perceived improvement and expectations and patients’ adherence to the exercise program. Furthermore, patients’ perceived usability, usefulness and satisfaction with multimedia animations were also measured. Subjects were followed for 24 weeks. Adequate multilevel regression models were implemented. Results: A total of 154 subjects were included (80 in the control group and 74 in the experimental group). Both groups improved over time, but there were no significant between-group differences regarding Shoulder Pain and Disability Index, pain intensity, patients’ satisfaction, perceived improvement or expectations. Subjects showed a decrease in adherence to exercise over time, without significant between-group differences. Conclusions: The implementation of multimedia animations may not provide additional benefits when a well-designed paper-based program and therapist support are already established.

Background/Objectives: In rotator cuff-related shoulder pain (RCRSP) without associated tendon rupture, therapeutic exercise is one of the main treatment strategies; however, the mechanisms through which it exerts its effects remain poorly understood. The aim of this study was to analyze the role of two potential mechanisms of action: increases in muscle strength and changes in the microarchitecture of the supraspinatus muscle. Methods: This prospective study included 39 patients with RCRSP treated with a strengthening exercise program. Muscle strength was assessed using dynamometry, and supraspinatus muscle stiffness was evaluated using shear wave elastography (SWE) at baseline and after 6 months of exercise. These measurements were correlated with clinical and perceived improvement in the patients. Results: Thirty-seven patients completed follow-up. At 6 months, 67.6% of participants reported being much better or fully recovered, 29.7% reported being somewhat better, and only one patient (2.7%) reported worsening. Overall, the increase in muscle strength was small. In participants reporting marked improvement or full recovery, strength gains were slightly greater, but a significant increase in supraspinatus muscle stiffness was observed. In contrast, participants with mild improvement or worsening showed smaller strength gains and no changes in muscle stiffness. Conclusions: Strength gains following strengthening exercises in RCRSP are small and of limited clinical relevance. In contrast, increased supraspinatus muscle stiffness assessed by SWE was observed after the exercise intervention and may reflect exercise-related adaptations; however, its biological meaning should be interpreted with caution.