Real versus sham manual therapy in addition to therapeutic exercise in the treatment of non-specific shoulder pain: a randomized controlled trial

Review written by Dr Jarod Hall info

Key Points

  1. Shoulder pain is among the most common musculoskeletal complaints and non-specific shoulder pain (NSSP) is the most common disorder of the shoulder.
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Non-specific shoulder pain (NSSP) is the most common disorder of the shoulder and the guideline based first choice of treatment for NSSP is physiotherapy, specifically exercise based approaches (1,2). Other treatments such as taping, electrotherapy, and manual therapy may be proposed as adjunct treatments (3,4).

In general, manual therapy has been shown to produce benefits at short-term follow-ups in various musculoskeletal disorders. Manual therapy is thought to produce a neurophysiological response that activates the descending inhibitory pathways, leading to a reduction in the symptomatology of patients which may improve ability to participate in an exercise program and subsequently improve outcomes (5).

This study hypothesized that the addition of manual therapy to a therapeutic exercise program would produce better benefits in comparison with the same exercise program with sham manual therapy procedures in the management of patients with NSSP.

The guideline based first choice of treatment for non-specific shoulder pain is physiotherapy, specifically exercise based approaches.
Highly complex rehab protocols may not be necessary to achieve significant and positive outcomes in the management of non-specific shoulder pain.


  • For this study, a convenience sample of subjects with NSSP was recruited through announcements at the Benemérita Universidad Autónoma de Puebla, Mexico. Subjects were then randomized into 3 groups.
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