Painful shoulder: Exercise can reduce pain and improve mobility and function
Shoulder pain is common, especially as people age. It may limit your ability to reach over your head, play catch with your kids, wash your hair, reach behind you, or perform some of your favorite activities. Your doctor may refer to this as subacromial shoulder pain, impingement, or rotator cuff tendinopathy, but all these fancy terms refer to the same pain in your shoulder. Although the consequences of shoulder pain can be very limiting, the good news is that most people see improvements with physical therapy! A literature review published in February 2020 by the Journal of Orthopedic and Sports Physical Therapy (JOSPT) showed that exercises are the best way to manage your shoulder pain.
Physical therapy treatments for shoulder pain
Your physical therapist likely will have may tricks up his or her sleeve to decrease your pain. However, the aforementioned review published in the JOSPT suggests that they are not all equally effective. Potential treatment methods and a summary of their recommendations are listed below.
- Exercise: There is high-level evidence that suggests supervised and home-based exercises are effective both short-term (8 weeks) and at long-term follow-ups (>3 months) in decreasing pain and improving range of motion. Supervised strengthening and stretching exercises can provide similar short-term benefits to those of a corticosteroid injection, and long-term outcomes similar to a subacromial decompression surgery. Shoulder flexibility exercises, scapular stability exercises, and rotator cuff strengthening are strongly recommended for patients with shoulder pain.
- Exercise and manual therapy: Moderate to high-level evidence shows that manual therapy with exercise may help decrease pain short-term. The JOSPT strongly recommends combining these two treatment techniques for improved mobility and function.
- Laser therapy: There is minimal evidence that laser therapy alone is effective in improving shoulder pain and function. Based on moderate-level evidence, laser therapy may improve function when used with exercise. Overall, it is strongly recommended that laser therapy is not used as a treatment for shoulder pain, based on the lack of evidence supporting its effectiveness.
- Ultrasound: There is minimal evidence supporting the effects of therapeutic ultrasound on shoulder pain.
In summary, exercise is the most highly recommended form of treatment for shoulder pain. Although corticosteroid injections technically are not physical therapy treatments, the study reviewed some articles that discussed the effectiveness of these as well. Evidence shows that a corticosteroid injection, especially if guided by ultrasound, is better than no treatment at all for shoulder pain. There is moderate evidence that supports use of corticosteroid injections either as a solitary treatment or in addition to exercise-based therapy. However, when compared head-to-head, injections are less effective than exercises in decreasing shoulder pain.
Even though it might not be the fastest or easiest route to decreasing your shoulder pain, there is concrete evidence that supports the use of exercises to improve shoulder function. Your physical therapist will work with you to select exercises that are sufficiently challenging and applicable to your goals. Let us help you get back to the activities you love, without pain.
Source: Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 131-141. doi:10.2519/jospt.2020.8498