Up until today, exercise seems to be the most effective treatment for pain and disability in the shoulder region. Shoulder pain is often recurrent within the same year. Recent research has shown that exercise is as effective as a costicosteroid injection in non-specific shoulder pain and impingement.

On top of that, it has been shown that 40% of all patients with shoulder pain also present with movement disorders of the cervicothoracic spine.

A clinical prediction rule has been developed which can determine whether manual therapy of the cervicothoracic spine is effective in patients with shoulder pain (at least 3 positive). This prediction rule includes shoulder flexion less than 127, shoulder internal rotation les than 53 in 90 degrees abduction, negative Neer test, less than 90 days symptoms and no medication use.