Adding manual therapy to an exercise program improves long-term patient outcomes over exercise alone in patients with subacromial shoulder pain: a randomized clinical trial

Review written by Robin Kerr info

Key Points

  1. Manual therapy added to a resistance and stretching exercise program improved long-term shoulder disability, satisfaction, and perceived benefit in patients with subacromial pain.
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Subacromial shoulder pain is a common clinical presentation, implicating structures in the subacromial space (rotator cuff tendons, bursitis, long head of the biceps). Recovery is estimated to be 50-60%, with persistent problems a significant clinical issue (1). Physiotherapy, particularly progressive resistance training and stretching (EX), is recommended as the first line of treatment (2). Manual therapy (MT) has been a recommended in addition to EX, however, low certainty has resulted due to heterogeneity in the research (3).

The authors of this study state that the question of whether MT is a useful addition to EX in the management of subacromial pain has not been definitively answered, so returned to shoulder data collected 12 years prior to this study to examine the question. They aimed to assess primary outcomes of pain and disability and secondary measures of global effect of treatment, satisfaction with shoulder and the need for additional healthcare after discharge following six weeks of treatment in the study.

Recovery of subacromial shoulder pain is estimated to be 50-60%, with persistent problems a significant clinical issue.
Could it be the therapeutic relationship established with MT in the initial six weeks resulted in more favourable reporting at six and 12 months?


A multi-clinic parallel randomized controlled trial (RCT) following CONSORT guidelines was performed between 2008-2011.

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