Are scapular stabilization exercises needed for subacromial pain?

A recent study sought to determine the effect of adding scapular stabilization exercises to a progressive periscapular strengthening protocol on disability, pain, muscle strength, and ROM in patients with subacromial pain syndrome.

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STUDY: Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial – Hotta et al. Oct 2020

Study reviewed by Jarod Hall

Key points from the study

• Scapular focused exercises that place emphasis on the movement and position of the scapulae are a commonly employed treatment approach.
• Based on the results of this well-designed study, there is no relevant clinical value in adding these exercises on top of a resistance strengthening protocol targeting the periscapular muscles.

Okay, let’s dive into it!

Background and Objective

Subacromial pain syndrome (SAPS) is a common shoulder condition often characterized by rotator cuff muscle weakness and pain reported from, or worsened by, repetitive overhead activities.

Currently, strong evidence supports an exercise-based approach to alleviate pain and improve function for patients with SAPS. To date, only two studies have tested the benefits of adding scapular stabilization exercises to an exercise-based intervention in patients with SAPS, and these studies demonstrated conflicting results.

Methods/What They Did

This study was a randomized controlled trial (RCT) with a two-arm parallel design. 113 individuals with SAPS were recruited and randomly allocated into two treatment groups: the periscapular strengthening group (PSG) and the scapular stabilization group (SSG).

The patients allocated to the SSG performed the same six periscapular strengthening exercises applied to PSG, as well as an additional six scapular stabilization exercises, emphasizing retraction and depression of the scapula. The exercises were performed three times a week for 8 weeks.

Results/What They Found

There was no significant difference between groups for the total mean score of shoulder function during all periods of follow-up. There were also no differences among the mean values for pain, kinesiophobia, global perceived effect, ROM, and muscle strength between the two groups during all of the follow-up periods.

Limitations/Things to Keep in Mind

• The therapist was not blinded to the treatment assignment.
• Psychosocial factors with some potential to influence shoulder pain outcomes were not assessed.

Clinical Implications

According to this study, there is no relevant clinical value in adding non-load exercises emphasizing retraction and depression of the scapula over a progressive resistance strengthening protocol directed to the periscapular muscles. An exercise strategy that focuses on scapular repositioning and scapular specific exercises does not generate a greater reduction in symptoms, and there is no evidence that it influences scapular positioning.

These findings call into question the common clinical focus on assessing scapular position/movement during upper extremity motions.

It appears that exercise approaches which focus on general strengthening and progressive loading are sufficient to elicit improvements in pain and shoulder function in those with SAPS.