Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Sean Y Abdulla; Danielle Southerst; Pierre Côté; Heather M Shearer; Deborah Sutton; Kristi Randhawa; Sharanya Varatharajan; Jessica J Wong; Hainan Yu; Andrée-Anne Marchand; Karen Chrobak; Erin Woitzik; Yaadwinder Shergill; Brad Ferguson; Maja Stupar; Margareta Nordin; Craig Jacobs; Silvano Mior; Linda J Carroll; Gabrielle van der Velde; Anne Taylor-Vaisey

doi:10.1016/j.math.2015.03.013

Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Man Ther. 2015 Oct;20(5):646-56. doi: 10.1016/j.math.2015.03.013. Epub 2015 Apr 1.

Authors

Sean Y Abdulla¹, Danielle Southerst², Pierre Côté³, Heather M Shearer⁴, Deborah Sutton⁴, Kristi Randhawa⁴, Sharanya Varatharajan⁴, Jessica J Wong⁵, Hainan Yu⁴, Andrée-Anne Marchand¹, Karen Chrobak¹, Erin Woitzik¹, Yaadwinder Shergill⁶, Brad Ferguson¹, Maja Stupar⁴, Margareta Nordin⁷, Craig Jacobs⁸, Silvano Mior⁹, Linda J Carroll¹⁰, Gabrielle van der Velde¹¹, Anne Taylor-Vaisey¹²

Affiliations

¹ Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
² Division of Undergraduate Education, Canadian Memorial Chiropractic College, Canada; Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada. Electronic address: dsoutherst@mtsinai.on.ca.
³ UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Canada.
⁴ UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
⁵ Division of Undergraduate Education, Canadian Memorial Chiropractic College, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
⁶ Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada; Department of Anaesthesia, The Ottawa Hospital, Canada.
⁷ Departments of Orthopedic Surgery and Environmental Medicine, NYU School of Medicine, New York University, USA.
⁸ Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada; Division of Clinical Education, Canadian Memorial Chiropractic College, Canada.
⁹ Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
¹⁰ Department of Public Health Sciences, Injury Prevention Centre, School of Public Health, University of Alberta, Canada.
¹¹ Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada; Faculty of Pharmacy, University of Toronto, Canada; Institute for Work and Health, Canada.
¹² UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada.

PMID: 25920340
DOI: 10.1016/j.math.2015.03.013

Abstract

Background: Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear.

Objective: Determine the effectiveness of exercise for shoulder pain.

Methods: We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology.

Results: We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care.

Conclusion: The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care.

Systematic review registration number: CRD42013003928.

Keywords: Exercise; Shoulder pain; Subacromial impingement syndrome; Systematic review.

MeSH terms

Disease Management
Exercise Therapy / methods*
Female
Humans
Male
Ontario
Pain Measurement
Practice Guidelines as Topic
Prognosis
Randomized Controlled Trials as Topic
Severity of Illness Index
Shoulder Impingement Syndrome / diagnosis
Shoulder Impingement Syndrome / rehabilitation*
Shoulder Pain / diagnosis
Shoulder Pain / rehabilitation*
Soft Tissue Injuries / diagnosis
Soft Tissue Injuries / rehabilitation*
Systematic Reviews as Topic
Treatment Outcome