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Review shows exercise therapy one of the best shoulder treatments



Comprehensive study needed to pull together all research on the topic


Complaints related to shoulder pain are the third-most common after those of the back and neck. About 29 out of every 1,000 individuals will have an issue with shoulder pain each year, and it has the highest incidence in women and people between the ages of 45-64. About 36% of these individuals have a condition called shoulder impingement syndrome (SIS), which is a generic term for several shoulder disorders that all lead to pain, disability and a reduced quality of life. There are many conservative (non-surgical) treatments available for SIS and an abundance of research on their effectiveness, but there is yet to be a comprehensive overview that has pulled all of these studies together and compared them to one another. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted to provide this needed overview on various conservative treatments for SIS.



Six databases searched for relevant studies


Investigators performed a search of six major medical databases for high-quality studies called randomized-controlled trials (RCTs) that evaluated the effectiveness of a conservative treatment for SIS. RCTs randomly assign participants to a treatment group and then compare them to one—or more—other groups to gauge how well an intervention works, and they are considered the gold standard of individual research studies. This search led to 324 RCTs being screened and 200 of these being accepted into the final analysis. Conservative treatments evaluated in these studies included exercise therapy, a form of hands-on therapy called manual therapy, steroid injections, taping and non-steroidal anti-inflammatory drugs (NSAIDs), among others. Once collected, the findings from these RCTs were compared to one another and the quality of each study was assessed to determine how reliable these findings actually were.



Despite low quality of evidence, exercise is still recommended for patients with SIS


On the whole, results were supportive of both exercise therapy and manual therapy for SIS patients. For pain alone, studies showed that manual therapy was superior to no treatment or a sham treatment, and that when combined with exercise, it was more effective than exercise alone. Manual therapy was also found to have immediate effects. Regarding pain and function, exercise therapy was found to be superior to no treatment, and specific exercises were found to be more effective than non-specific exercises. Finally, studies also showed that exercise therapy was superior to non-exercise modalities—like ultrasound and electrical stimulation—for improving flexibility. Unfortunately, the quality of the research was deemed very low, which was due to lack of consistency across studies and a high risk of bias. But in spite of this shortcoming, the researchers still concluded that exercise therapy should be recommended as the first line of treatment for SIS patients, and that adding manual therapy may lead to even better results. Individuals dealing with SIS symptoms are therefore encouraged to see a physical therapist for a comprehensive treatment program that is sure to include various exercises and manual therapy. Patients should also be aware that visiting a physical therapy clinic now can be especially advantageous if they already met their insurance deductible or out-of-pocket maximum for 2018, since these visits may be covered for the rest of the year.



-As reported in the September ’17 issue of the British Journal of Sports Medicine
November 13, 2018