An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain.

Louise Pieters, Jeremy Lewis, Kevin Kuppens, Jill Jochems, Twan Bruijstens, Laurence Joossens, Filip Struyf

PMID: 31726927
DOI: 10.2519/jospt.2020.8498

Abstract

Objective: To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain.

Design: Umbrella review.

Literature search: An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews.

Study selection criteria: Nonsurgical treatments for subacromial shoulder pain.

Data synthesis: Sixteen systematic reviews were retrieved. Results were summarized qualitatively.

Results: A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound.

Conclusion: There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.

Keywords: conservative treatment; exercise; rotator cuff; shoulder pain; systematic review; tendinopathy.

Comment in

April 2020 Letter to the Editor-in-Chief.

Littlewood C, Jesson T, Foster N.J Orthop Sports Phys Ther. 2020 Apr;50(4):216-217. doi: 10.2519/jospt.2020.0202.PMID: 32241233

CORE Omaha Explains…

By Dr. Mark Rathjen PT DPT CSCS

“Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase.”

What does this mean?

The above review suggest that exercise and physical therapy, in combination with manual therapy techniques can be a great treatment option for shoulder pathology. Not all shoulder conditions need a surgical interventions, conservative approaches can often lead to the same if not better outcomes. Overall what works best for you is more specific to the amount of damage and cause of the impingement.

Manual Physical therapy techniques include joint mobilizations, graston technique, and dry needling. Mechanics training and postural training are also very effective for most conditions.

Many surgeries are unnecessary. Conservative treatment is very effective, but not for all conditions. Seek guidances from a qualified Doctor of Physical therapy and/or orthopedic surgeon to determine what’s best for you. Surgery is not always the only or best options…

Conservative treatment to restore normal gleno-humeral motions will help to facilitate a long term solution to your shoulder issues.

Come see the CORE difference at CORE Physical Therapy in Omaha.

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