Physical rehabilitation instead of surgery for patients with shoulder pain: Treatment effect, knowledge gaps and future directions

Abstract

Introduction: Shoulder pain is one of the most common musculoskeletal complaints and the term ‘subacromial pain syndrome’ is used to describe the most common clinical subgroup. A recent practice guideline for surgery concludes that subacromial decompression should not be offered to patients with subacromial pain. Subsequently, the Norwegian Secretary of State for Health, Bent Høie, in an interview advised that this patient group should receive the most effective treatment, namely physical rehabilitation. Main section: The current paper provides an overview of evidence-based physiotherapy treatment for patients with subacromial pain and discusses relevant evidence. The paper then outlines knowledge gaps, such as the degree of supervision and the content of exercise regimes. Recommendations from leading musculoskeletal research teams suggest an increased focus on self-efficacy and self-management. With this in mind, the authors discuss future directions for treatment of shoulder pain. End section: With the more prominent role physical rehabilitation now has been given, it is necessary for the physiotherapy profession to respond honestly and responsibly. The treatment model should be further developed in line with evidence, and this might challenge the current knowledge-base of physiotherapists.

Keywords

• shoulder pain
• physiotherapy
• patient education
• evidence based
• treatment