Manual therapy and exercise for rotator cuff disease

Abstract

Despite identifying 60 eligible trials, only one trial compared a combination of manual therapy and exercise reflective of common current practice to placebo. We judged it to be of high quality and found no clinically important differences between groups in any outcome. Effects of manual therapy and exercise may be similar to those of glucocorticoid injection and arthroscopic subacromial decompression, but this is based on low quality evidence. Adverse events associated with manual therapy and exercise are relatively more frequent than placebo but mild in nature. Novel combinations of manual therapy and exercise should be compared with a realistic placebo in future trials. Further trials of manual therapy alone or exercise alone for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.

General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care

“…We do not know how many patients attend physiotherapy following informal referral or recommendation from their GP. Further, uncertainty regarding the efficacy of exercise (recent Cochrane review published after the National survey) [49] may also impact on GPs decision making when managing RCRP. Finally, Australia has a maldistributed GP workforce [50] and a rapidly increasing population attendance rate to general practice [51], so it is possible that GPs lack the time to adequately assess and manage RCRP within their primary care setting [31,47].…”

Can the efficacy of subacromial corticosteroid injection be improved using a single-session mobilization treatment in subacromial impingement syndrome? A randomized single-blind controlled trial

“…The MT and exercise are common treatment methods for SIS as a part of physical therapy. Improving function and ROM and decreasing pain are the main goals of both treatments [18,19]. A recently published metaanalysis reported that corticosteroids were superior to control and physical therapy modalities, but only during a short-term follow-up period.…”

Sustainability and Clinical Effectiveness of Inpatient Rehabilitation in Painful Shoulder Diseases

“…glucocorticoid injection) [2]. Studies that consider physiotherapy for treating shoulder pain and function showed that active physiotherapy has a significant benefit to the patients in short-and longterm compared to non-or placebo-treatment.…”

“…Therapies to treat musculoskeletal disorders of the shoulder are amongst others the manual therapy, the therapeutic ultrasound, low-level laser therapy, acupuncture and the pulsed or static electromagnetic field therapy, applied alone or in combination [2]. Kuhn summarized the outcome of eleven randomized, controlled trials to demonstrate that exercise (as applied in rehabilitation programs) in the treatment of rotator cuff impingement has statistically and clinically benefits on pain reduction and improvement of function [3].…”