An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain

J Orthop Sports Phys Ther. 2020 Mar;50(3):131-141. doi: 10.2519/jospt.2020.8498. Epub 2019 Nov 15.


Objective: To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain.

Design: Umbrella review.

Literature search: An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews.

Study selection criteria: Nonsurgical treatments for subacromial shoulder pain.

Data synthesis: Sixteen systematic reviews were retrieved. Results were summarized qualitatively.

Results: A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound.

Conclusion: There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.

Keywords: conservative treatment; exercise; rotator cuff; shoulder pain; systematic review; tendinopathy.

Publication types

  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Combined Modality Therapy
  • Electric Stimulation Therapy
  • Exercise Therapy*
  • Extracorporeal Shockwave Therapy
  • Humans
  • Injections
  • Laser Therapy
  • Magnetic Field Therapy
  • Musculoskeletal Manipulations*
  • Shoulder Impingement Syndrome / therapy*
  • Ultrasonography


  • Adrenal Cortex Hormones