Physiotherapy for subacromial shoulder pain: review update

...what is the latest evidence?

There is an increasing amount of strong evidence supporting the use of exercise for subacromial shoulder pain (SSP). However, research is still needed to determine specific exercise parameters.

Manual therapy was also found to be strongly recommended in the initial stages of treatment. On the contrary, there was moderate evidence that laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic therapy and ultrasound do not have any effect on SSP.

These are conclusions from a recent systematic review that builds on previous work to determine if recent literature provided further understanding in the management of subacromial shoulder pain.

Nine of the 16 reviews had high methodological quality, while the remaining 7 were graded as having moderate quality. The fact that some studies may have been included in more than one of the included reviews may introduce a representation bias.

The authors highlight that there is consistent evidence exercise should be considered as the primary treatment option for SSP, due to its clinical benefits and cost-effectiveness, while multimodal therapy might be effective in rotator cuff tendinopathy and manual therapy may provide an additional benefit when combined with exercise.

> From: Pieters et al., J Orthop Sport Phys Ther 50 (2020) 131-141 . All rights reserved to Journal of Orthopaedic & Sports Physical Therapy. Click here for the online summary.

Expert opinion

Although this may not constitute new information for many physiotherapists, this review provides evidence originating from a very broad analysis of the literature and constitutes an important effort regarding the recommended management of SSP.

The results show a clear need to avoid passive modalities and to focus on exercise and engaging the patient in the treatment process.

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