Physiotherapy for Shoulders: What Works Best for Shoulder Pain?

Jul 11, 2018

If you’ve been experiencing shoulder pain, you’re not alone. Up to 67% of adults report shoulder-related symptoms at some point in their lives. For some, the pain doesn’t go away and can turn into a long term challenge, affecting daily activities and quality of life. The important thing, however, is that you don’t accept pain as your “new normal”.

Since the shoulder is one of the most complicated joints in your body, there can be numerous reasons behind the pain. Regardless of the diagnosis, most people probably want to avoid surgery or other invasive methods. Therefore, they usually try different conservative treatments first, such as stretching and strengthening exercises, joint mobilisation and manipulation, taping, proprioceptive training, ultrasound, and acupuncture, to name but a few. However, it can sometimes be difficult to establish which treatment option is right for you. Also, as a client, you might not be familiar with the body of evidence (the science) that supports (or doesn’t support) the effectiveness of each method.

Exercise vs Other Treatment Options for Shoulder Pain

Dr Paula Rezende Carmago and her team reviewed 64 high-quality studies that assessed the effectiveness of various physiotherapy treatments for shoulder pain. More specifically, they were interested in subacromial pain syndrome—previously known as shoulder impingement syndrome—which is among the most common conditions associated with shoulder pain, accounting for 44 to 60% of all cases[1].

Carmago’s team found that exercise and manual therapy were the most effective physiotherapy approaches to improve pain, function, and range of motion. Exercises based on stretching and strengthening of rotator cuff and scapular (shoulder blade) muscles showed to be as effective as arthroscopic surgery in all phases of the treatment. According to the review, manual therapy importantly contributed to the positive outcome, too. In contrast, Carmago didn’t find strong evidence for other physical therapy modalities, including taping, laser, and pulsed electromagnetic field (PEMF)[2]. The latter two actually showed to be as effective as a placebo.

Other studies confirmed that exercise therapy can indeed be very beneficial for shoulder pain. Its results are very often comparable to surgical interventions (yet, involve fewer risks and cost less)[3]. Generally, exercise is now considered the standard of care for shoulder pain. It’s an accepted first-line intervention for those diagnosed with subacromial pain syndrome [4].  In a nutshell, you really shouldn’t rush the decision to use surgical intervention. Instead, find a good physio and try to utilise some individualised exercise therapy and education first.

Not All Exercise is Created Equal

Although experts widely support the use of exercise as a therapy intervention for shoulder pain, it’s less clear what type of exercise protocol works best. Therefore, researchers have been evaluating specific shoulder resistance training programs. For instance, Eric J. Chaconas and his team compared a six-week protocol of eccentric training of the shoulder external rotators with a general exercise protocol. The eccentric training included the use of colour-coded bands, which ensured the load and intensity were increasing as weeks went by. Chaconas’ team concluded that the eccentric program was superior to a general exercise protocol[5].  However, we’ll need more research before we can offer clients definite answers on the best evidence-based exercise protocol for shoulder pain. At Happy Physio, we use an individualised exercise approach specific to your daily demands, lifestyle factors and how your body presents – everyone is different.

What Else Can Influence Your Pain?

You might have noticed that there are factors other than your physical condition that can affect your pain levels, such as your personal, social and environmental circumstances. Chronic pain itself can be a huge mental challenge and often has a psychological impact and vice-versa; something most people that have experienced it can attest to. Having ongoing pain and little hope of improvement can be devastating. Therefore, your mental well-being is something that should not be ignored when approaching shoulder pain.

The experts at Happy Physio often include mental health variables when assessing the outcomes of physical conditions. For example, one study that looked at clients with a rotator cuff tear found that their mental health played an important role in the reported pain and function[6]. Another study that compared shoulder clients with hip clients concluded that the former was more often burdened with depression, anxiety, and concerns[7]. Therefore, you (and your health team) should view your pain in a holistic way and consider if all your needs are really being met.

If you are keen to get on the right pathway to stop your shoulder issues, book in for an appointment with our expert Physio’s today. Call 9272 7359 or book online!



[1] Van Der Windt, D., Koes, B., Boeke, A., Devillé, W., Bouter, L., & De Jong, B. (1996). Shoulder disorders in general practice: Prognostic indicators of outcome. British Journal of General Practice, 46(410), 519-523.

[2] Haik, M. N., Pires, E. D., Camargo, P. R., Alburquerque-Sendin, F., & Moreira, R. C. (2016). Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. British Journal of Sports Medicine, 50(18), 1124-34

[3] Saltychev, M., Laimi, K., Aarimaa, V., & Virolainen, P. (2015). Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disability And Rehabilitation, 37(1), 1-8.

[4] Hanratty, C. E., McVeigh, J. G., Kerr, D. P., Basford, J. R., Finch, M. B., Pendleton, A., & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 42(3), 297-316. doi:10.1016/j.semarthrit.2012.03.015

[5] Chaconas, E. J., Kolber, M. J., Hanney, W. J., Daugherty, M. L., Wilson, S. H., & Sheets, C. (2017). Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomized control trial. International Journal of Sports Physical Therapy, 12(7), 1121-1133.

[6] Wylie, J, Suter, T., Potter, M., Granger, E., & Tashjian, R. (2016). Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears. Journal of Bone and Joint Surgery – American Volume, 98(4), 251-256. doi:10.2106/JBJS.O.00444

[7] Bilberg, R., Nørgaard, B., Overgaard, S., & Roessler, K. K. (2014). Mental health and quality of life in shoulder pain patients and hip pain patients assessed by patient reported outcome. International Journal of Orthopaedic And Trauma Nursing, 18(2), 81-88. doi:10.1016/j.ijotn.2013.07.003