The Role of Therapeutic Exercise in the Conflicting and Unstable Shoulder

Abstract

Context: The use of therapeutic exercise and manual therapy in rehabilitation of the unstable and conflicting shoulder (UCS) is widespread. In the literature, there are several electromyographical studies that have analysed the effect of specific physical exercises and clinical trials on the effectiveness of specific rehabilitative protocols. However, it has not been established yet what is the best intervention for these disorders. Objective: In order to establish general recommendations for the treatment of UCS, we have reviewed the results of some electromyographical studies to identify the best exercises to recruit specifically the shoulder girdle muscles and some clinical trials that have proposed the utilisation of therapeutic exercise and manual therapy for UCS. Methods: Review of the literature of the last 10 years. We have searched Pedro, Medline and the Cochrane Library for randomised clinical trials, systematic reviews and electromyographical studies on rehabilitative protocols based on therapeutic exercise and manual therapy. Outcomes: It is common practice for clinicians to consider the involvement of patients with shoulder instability or impingement in a programme of exercises, before proceeding to a surgical intervention. Our analysis of the literature provides evidence of the efficacy of manual therapy associated with therapeutic exercises for decrease in pain, recovery of patient's strength and restoration of abilities. Conclusions: While the analysed studies are inconclusive, on the basis of the available data, we suggest some general rehabilitative principles for the treatment of the unstable and conflicting shoulder.

Low-Power Laser Treatment for Shoulder Pain

“…This finding points to the positive effect of exercise, which is known to be a basic therapeutic modality in shoulder pain relief and joint range of motion improvement when used alone or combined with specific physiotherapy programs. 43 The results of the comparison of the two groups in our study showed significantly better improvement only for passive extension range and palpation sensitivity for the laser group. While better passive extension range may be a result of the laser effect, it may also be due to our patient selection criteria, according to which patients with restriction of active and passive joint range of motion were also included in the study, regardless of the specific diagnosis for the shoulder pain.…”

A Retrospective, Descriptive Study of Shoulder Outcomes in Outpatient Physical Therapy

“…In addition, studies often focus on interventions for 1 or 2 subcategories of shoulder diagnosis, some with only a limited number of dependent variables. 3,6,7,8,22,29 This may limit the application of the study. Several studies have noted the recalcitrant nature of shoulder dysfunction.…”