# Sex Differences in Strength, Self-Estimation, and Pain Perception Based on Physical Activity After Rotator Cuff Repair

## TL;DR

The study found that higher physical activity after rotator cuff surgery improves early recovery, with women in low-activity groups reporting more pain than men.

## Contribution

This study identifies sex-based differences in pain perception and recovery outcomes following rotator cuff surgery in relation to physical activity levels.

## Key findings

- Higher physical activity groups showed better pain reduction and self-estimation scores at 6 and 12 weeks post-surgery.
- Women in low-activity groups reported significantly higher pain levels at 12 weeks compared to men in the same group.
- Isokinetic strength improved more in high-activity groups at 12 weeks but not at 24 weeks.

## Abstract

Background: The role of physical activity in early recovery following arthroscopic rotator cuff repair (ARCR) remains unclear, particularly regarding potential sex differences. This study examined the effects of physical activity on pain, self-estimation, and strength recovery after ARCR in middle-aged and older adults. Methods: Patients who underwent ARCR were classified into high physical activity (HPA, n = 94) and low physical activity (LPA, n = 99) groups based on the International Physical Activity Questionnaire. The Visual Analog Scale (VAS) for pain and the American Shoulder and Elbow Surgeons (ASESs) score for self-estimation were assessed preoperatively and at 6, 12, and 24 weeks postoperatively. Isokinetic shoulder strength was measured at the same intervals except for the 6-week assessment. Results: All groups demonstrated significant improvements in pain reduction and self-estimation over time (p < 0.05). At 6 and 12 weeks, the HPA group showed significantly lower VAS scores and higher ASES scores than the LPA group (p < 0.05). Notably, at 12 weeks, men in the LPA group exhibited pain levels comparable to the HPA group, whereas women in the LPA group continued to report significantly higher pain levels (p < 0.05). Isokinetic strength assessment revealed greater flexion and external rotation strength in the HPA group at 12 weeks (p < 0.05), though no significant between-group differences were observed at 24 weeks. Conclusions: Higher physical activity levels were associated with better early pain relief and self-estimation after ARCR, particularly within the first 12 weeks. These findings suggest that structured physical activity may enhance postoperative outcomes, with potential sex-based differences in pain perception.