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Shoulder Pain: What Works? What Doesn’t?

Shoulder pain is common and increases with age. It’s associated with reduced sports performance, cessation of sports, time off work, and reduced quality of life.

What’s more, suboptimal treatment makes incomplete resolution frequent in the general population.(1) Some common treatment approaches work; others do not. In previous decades, the science regarding conservative shoulder pain treatment has been sparse, but there have been a number of good studies in the past ten years. This past March, the Journal of Orthopaedic & Sports Physical Therapy published an up-to-date review of the science to see what physiotherapy approaches work and which ones don’t.

What Is Subacromial Shoulder Pain?

The current study limits itself to subacromial shoulder pain. This describes pain located at the top and outside (lateral area) of the shoulder. The pain is typically exaggerated by overhead activity. The umbrella term “subacromial shoulder pain” includes many other diagnoses such as subacromial impingement syndrome, rotator cuff tendinopathy / tendinitis, rotator cuff-related shoulder pain, shoulder bursitis, and more.

Researchers Strongly Recommend Exercise Therapy for Shoulder Pain

Exercise therapy led to outcomes similar to decompression surgery in the long-term. Exercise treatments generated short-term pain relief comparable to corticosteroid injections. The addition of manual therapy reduces pain in the short term.

Shoulder Treatments That Don’t Work

Based on review of the current science, researchers recommended against laser therapy, therapeutic ultrasound, extracorporeal shockwave therapy, and pulsed electromagnetic energy due to limited effectiveness. Note, the researchers make these recommendations specifically for subacromial shoulder pain and not for any other conditions. In some cases, especially for therapeutic ultrasound, the data was still somewhat weak, leaving open the possibility that new studies could reverse the findings.

Free E-Book: Understanding Shoulder Pain


  1. Hill CL, Gill TK, Shanahan EM, Taylor AW. Prevalence and correlates of shoulder pain and stiffness in a population‐based study: the North West Adelaide Health Study. International Journal of Rheumatic Diseases. 2010 Aug;13(3): 215-22.
  2. Pieters L, Lewis J, Kuppens K, Jochems J, Bruijstens T, Joossens L, Struyf F. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of Orthopaedic & Sports Physical Therapy. 2020 Mar; 50 (3):131-41.

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