Specific exercises lessen pain and boost physical function and mobility in people with shoulder impingement.They should be considered for treating the condition, even though the quality of the evidence is very low, concludes a pooled analysis of the available data.To assess the effectiveness of strategies to tackle the pain and reduced function/mobility caused by shoulder impingement, the authors reviewed 200 relevant randomized controlled trials published up to January 2017 that evaluated a range of non-surgical treatments.These primarily included exercise, corticosteroid injections, anti-inflammatory drugs (NSAIDs), manual therapy, laser and extracorporeal shockwave therapies, and tape or nerve block.
Analysis of the pooled data showed that exercise was better than doing nothing for relieving pain and improving physical function, with specific exercises more effective than generic ones. And it was more effective for boosting mobility than strategies that didn’t include it. Corticosteroid injections were better than none for pain relief and improving physical function, particularly if done under ultrasound guidance. NSAIDs were also better than placebo, as was manual therapy, the findings showed.
And when combined with exercise, manual therapy was better than exercise alone, but only after the shortest period of monitoring. Similarly, laser, extracorporeal shockwave therapy, and tape were marginally better than sham treatments.‘Although our review only provides very low-quality evidence, we suggest that exercise may be considered as the core conservative treatment for shoulder impingement,’ write the authors.‘Furthermore, manual therapy, laser and tape might provide additional benefit.’
Steuri R et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. British Journal of Sports