This systematic review and meta-analysis evaluated the effectiveness of thoracic spine manual therapy (TSMT) for individuals with subacromial impingement syndrome (SIS), a common shoulder condition that often causes pain, reduced function, and limited range of motion. The authors systematically searched multiple databases for randomized controlled trials comparing TSMT (either alone or as an adjunct) with physiotherapy alone or placebo controls. In total, 10 RCTs with 444 participants were included. The authors found that TSMT, delivered alone or in combination with physiotherapy, resulted in significant short- to intermediate-term improvements compared with control or placebo interventions. High-quality evidence demonstrated large reductions in shoulder pain at follow-ups ranging from 2 to 6 weeks and meaningful improvements in shoulder-related disability at intermediate time points. Moderate-quality evidence also supported gains in shoulder internal and external rotation. Overall, the findings indicate that thoracic spine manual therapy is an effective intervention for reducing pain and improving function and range of motion in people with subacromial impingement syndrome, particularly in the short to medium term. ABSTRACT

This three-arm randomized clinical trial evaluated the effects of a multimodal intervention combining manual therapies, cervical exercises, and therapeutic pain neuroscience education (MUG) compared with manual therapy alone (MTG) or pain neuroscience education alone (TEG) in 75 adults with migraine. Over a 12-week treatment period, all groups demonstrated significant improvements in headache impact (HIT-6), but the timing and magnitude differed: MTG showed early improvement at week 4, TEG surpassed MTG by week 12, and MUG achieved the most sustained reductions at follow-up. Multimodal treatment also led to superior improvements in headache frequency, intensity, neck pain, neck disability, allodynia, quality of life, pain catastrophizing, and kinesiophobia. These findings indicate that while all interventions were effective, the multimodal approach provided the greatest and most durable benefits for both headache and neck-related outcomes, as well as psychosocial measures. FREE FULL TEXT

A 2025 RCT with 60 patients with RCTs investigated the effect of Mulligan mobilization compared with corticosteroid injections. Results indicated that MM showed significantly better results for pain, ROM and proprioception, but both treatment methods were successful for short-term outcomes. The authors concluded that the MM approach combined with conventional exercises seems to be a more effective approach for improving shoulder pain, function, and proprioception in this patient population. ABSTRACT

A 2025 systematic review and network meta‑analysis compared the effect of combination physical therapy (exercise plus manual therapy) vs single‑modality treatments for adults with rotator cuff related shoulder pain (RCRSP). 11 RCTs (n=548) RCTs were included. Results showed that combination therapy tended to show the greatest improvements in both pain intensity and shoulder function at 12 weeks compared with other approaches, although the confidence intervals were wide and crossed the null, indicating statistical uncertainty. Exercise therapy alone provided moderate functional benefits, and Kinesio taping showed moderate effects on pain relief, but these did not reach clear statistical significance. The authors concluded that exercise plus manual therapy appears to be the most promising non‑invasive treatment for pain and functional improvement in RCRSP, but emphasized the need for larger, high‑quality trials to confirm these findings and establish long‑term effectiveness. FREE FULL TEXT

A 2025 assessor‑blinded randomized crossover trial of 24 participants investigated the analgesic effects of MWM combined with exercise compared with exercise alone for LET. Results indicated that provided hypoalgesia during exercise, whereas performing the same exercise without MWM did not produce an analgesic effect. This suggests that the addition of manual therapy techniques like MWM may enhance the immediate pain‑reducing benefits of exercise in this patient population, potentially making rehabilitation more comfortable and effective and increase patient adherence. FREE FULL TEXT

A 2025 systematic review and meta-analysis investigated the effects of exercise training including balance training and aerobic training on fear of falling (FOF) and number of falls (NoF). 14 RCTs were included. There was a generally high risk of bias reported with selective reporting of results. Results of the meta-analysis indicated that exercise training reduced FOF and fall incidence in older patients with osteoporosis or osteopenia. The authors recommend inclusion of tailored exercises for fall prevention. ABSTRACT

A 2025 double-blind RCT of 33 patients 4 weeks after surgery evaluated the impact of adding IASTM to standard postoperative rehabilitation after arthroscopic rotator cuff repair. Results showed that IASTM plus conventional therapy yielded significantly greater improvements in pain at rest, activity, and night, better shoulder range of motion, and higher functional scores after 4 weeks compared with conventional therapy alone. Both groups improved in kinesiophobia but differences between groups were not statistically significant. Incorporating IASTM into rehabilitation protocols can enhance short-term outcomes, specifically reduce pain and improve shoulder mobility and function beyond what conventional therapy alone achieves. ABSTRACT

A 2025 systematic review explored the prevalence of harm with suprascapular nerve blocks for shoulder pain. 111 studies were included and 168 episodes of harm across 4142 participants were reported. Results showed a range of severity, from pneumothorax, transient motor weakness to localized pain and bruising. Although the incidence of harm was low, there were also poor outcomes reported. The risk of physical harm should be considered and the patient informed for full disclosure and informed consent. FREE FULL TEXT

A 2025 systematic review and meta-analysis assessed the effect of MWM vs other physical therapy interventions. 27 studies (n=1157) were included. Outcomes included pain, function and range of motion. Results indicated that MWM was as effective for pain intensity and shoulder abduction as other physical therapy interventions, with no clinically significant difference. ABSTRACT

A 2025 systematic review and meta-analysis evaluated the effectiveness of thoracic spine thrust manipulation for SIS. 14 RCTs (n=749) were included. Results showed no significant improvement in clinical outcomes after thoracic spinal thrust manipulation. The authors concluded that multimodal treatment with exercise and other therapies for management of SIS. ABSTRACT

A 2025 systematic review addressed the effect of TPT for RC shoulder pain. Primary outcomes consisted of pain intensity and function. Secondary outcomes included pressure pain threshold (PPT) and number of myofascial trigger points (MTrP). 7 studies were included in the meta-analysis. Results showed that TPT were effective for pain in the short-term. TPT was as effective for pain as other passive treatments and more effective for functional improvement. The authors concluded that TPT may be recommended as part of a comprehensive treatment program. ABSTRACT

A 2025 systematic review investigated the appropriate timing for RTP and rehabilitation of ulnar collateral ligament. 105 articles were included (n=15,928; 15,077 surgical and 851 nonsurgical). Results showed a mean clearance for active range of motion of 15 days, full range of motion 40 days, and elbow strengthening exercises 32 days. Mean time to throwing activities was 120 days. Nonsurgical patients started all activities earlier than surgical patients. FREE FULL TEXT

A 2025 meta-analysis evaluated the effect of PSSE for SIS. 10 RCTs (n=628) were included. Outcomes included pain, range of motion, and function. Results indicated that PSSE significantly improved shoulder function and reduced pain in SIS, supported by studies with a low risk of bias and high quality. FREE FULL TEXT

A 2025 systematic review and meta-analysis assessed the effect of CI vs PT. 15 RCTs (n=1785) were included. Outcomes included pain and function. The results showed that CI alone was not more effective than PT. When CI was combined with PT there was a small to moderate improvement in pain and function over the short term when compared to CI alone. ABSTRACT

A systematic review and meta-analysis investigated the effectiveness of PRP compared to placebo or other treatments. 30 studies (n=2500) were included. Results indicated that PRP significantly reduced pain and improved function in the short term when compared to placebo, standard physical therapy or corticosteroid injections. Long-term benefits were limited. FREE FULL TEXT

A 2025 systematic review and meta-analysis analyzed the effect of manual therapy, massage, and acupuncture on mild to moderate CTS. 14 articles (n=110) were included. Outcomes included function, symptom severity, pain and sensory nerve conduction velocity (SNCV). Results found that manual therapy, massage and acupuncture effectively improved symptom severity, functional status, pain and SNCV in mild/moderate CTS. FREE FULL TEXT

A 2025 systematic review and meta-analysis evaluated the effectiveness of LDT (such as manual lymphatic drainage or kineseotaping) on CTS patients. 12 studies (n=479) were included. Outcomes were functional outcome scales, hand grip, median cross-sectional area, motor nerve conduction (MNCV) and sensory conduction velocities (SNCV). Results indicated that LDT techniques offer a promising non-invasive approach for CTS, decreasing pain, reducing edema, and enhancing nerve conduction. While intra-group improvements were notable, limited between-group differences were observed. FREE FULL TEXT

A 2025 systematic review and network meta-analysis evaluated the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis. 49 RCTs involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy and extracorporeal shock wave therapy also showed significant benefits. The authors concluded that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS. FREE FULL TEXT

A 2025 systematic review and meta-analysis evaluated the analgesic effect of HILT (>500mW) on DQT. 3 studies were included. Results showed no significant difference between HILT and control groups for pain intensity and disability. The authors concluded that the evidence does not support the superiority of HILT over conventional treatments such as splinting or exercise for treatment of DQT. ABSTRACT

A 2025 systematic review and meta-analysis assessed the effect of MWM vs other physical therapy interventions. 27 studies (n=1157) were included. Outcomes included pain, function and range of motion. Results indicated that MWM was as effective for pain intensity and shoulder abduction as other physical therapy interventions, with no clinically significant difference. ABSTRACT

A 2025 systematic review and meta-analysis evaluated the effectiveness of thoracic spine thrust manipulation for SIS. 14 RCTs (n=749) were included. Results showed no significant improvement in clinical outcomes after thoracic spinal thrust manipulation. The authors concluded that multimodal treatment with exercise and other therapies for management of SIS. ABSTRACT

A 2025 systematic review addressed the effect of TPT for RC shoulder pain. Primary outcomes consisted of pain intensity and function. Secondary outcomes included pressure pain threshold (PPT) and number of myofascial trigger points (MTrP). 7 studies were included in the meta-analysis. Results showed that TPT were effective for pain in the short-term. TPT was as effective for pain as other passive treatments and more effective for functional improvement. The authors concluded that TPT may be recommended as part of a comprehensive treatment program. ABSTRACT

A 2025 systematic review investigated the appropriate timing for RTP and rehabilitation of ulnar collateral ligament. 105 articles were included (n=15,928; 15,077 surgical and 851 nonsurgical). Results showed a mean clearance for active range of motion of 15 days, full range of motion 40 days, and elbow strengthening exercises 32 days. Mean time to throwing activities was 120 days. Nonsurgical patients started all activities earlier than surgical patients. FREE FULL TEXT

A 2025 meta-analysis evaluated the effect of PSSE for SIS. 10 RCTs (n=628) were included. Outcomes included pain, range of motion, and function. Results indicated that PSSE significantly improved shoulder function and reduced pain in SIS, supported by studies with a low risk of bias and high quality. FULL TEXT

A 2025 systematic review and meta-analysis assessed the effect of CI vs PT. 15 RCTs (n=1785) were included. Outcomes included pain and function. The results showed that CI alone was not more effective than PT. When CI was combined with PT there was a small to moderate improvement in pain and function over the short term when compared to CI alone. ABSTRACT

A systematic review and meta-analysis investigated the effectiveness of PRP compared to placebo or other treatments. 30 studies (n=2500) were included. Results indicated that PRP significantly reduced pain and improved function in the short term when compared to placebo, standard physical therapy or corticosteroid injections. Long-term benefits were limited. FREE FULL TEXT

A 2025 systematic review and meta-analysis analyzed the effect of manual therapy, massage, and acupuncture on mild to moderate CTS. 14 articles (n=110) were included. Outcomes included function, symptom severity, pain and sensory nerve conduction velocity (SNCV). Results found that manual therapy, massage and acupuncture effectively improved symptom severity, functional status, pain and SNCV in mild/moderate CTS. FREE FULL TEXT

A 2025 systematic review and meta-analysis evaluated the effectiveness of LDT (such as manual lymphatic drainage or kineseotaping) on CTS patients. 12 studies (n=479) were included. Outcomes were functional outcome scales, hand grip, median cross-sectional area, motor nerve conduction (MNCV) and sensory conduction velocities (SNCV). Results indicated that LDT techniques offer a promising non-invasive approach for CTS, decreasing pain, reducing edema, and enhancing nerve conduction. While intra-group improvements were notable, limited between-group differences were observed. FREE FULL TEXT

A 2025 systematic review and network meta-analysis evaluated the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis. 49 RCTs involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy and extracorporeal shock wave therapy also showed significant benefits. The authors concluded that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS. FREE FULL TEXT

A 2025 systematic review and meta-analysis evaluated the analgesic effect of HILT (>500mW) on DQT. 3 studies were included. Results showed no significant difference between HILT and control groups for pain intensity and disability. The authors concluded that the evidence does not support the superiority of HILT over conventional treatments such as splinting or exercise for treatment of DQT. ABSTRACT

A 2024 systematic review evaluated the current evidence comparing low-level to high-level laser therapy for musculoskeletal disorders. 12 RCT articles with 704 participants were included in the review; conditions included tennis elbow, carpal tunnel syndrome, chronic non-specific low back pain, knee arthritis, plantar fasciitis, and subacromial impingement. There were no statistical differences between the two interventions in pain, electrophysiological parameters, level of disability, quality of life, postural sway or pressure algometer. However, low-level laser therapy showed superiority in increasing grip strength compared to high-intensity laser therapy, while results significantly favored high-intensity laser therapy with respect to the long head of biceps diameter and cross-sectional area, supraspinatus thickness, and echogenicity and acromion-humeral distance. The authors concluded that current evidence suggests no superiority of either type of laser therapy in musculoskeletal disorders. FREE FULL TEXT

A 2024 systematic review assessed the effect of Blood Flow Restriction (BFR) on muscle strength and size of upper limb muscles. 23 studies were included in the analysis. Results demonstrated that resistance training with either high or low load resistance with BFR resulted in greater local, proximal, and distal gains in muscle size and strength compared to resistance training without BFR. ABSTRACT

A 2024 systematic review and meta-analysis assessed the effect of transcutaneous electrical acupoint stimulation (TEAS) on post-stroke motor recovery. 16 trials with 1,218 stroke patients were included in the analysis. Results indicated that TEAS significantly improved upper limb motor function and functional activities and reduced muscle tone in post-stroke patients. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the minimal clinically important difference (MCID) for the validity of the tool, Disability Instrument for the Arm, Shoulder, and Hand (DASH). In 2005, the Quick DASH was developed as a shortened version. 12 studies involving 1677 participants were included in the analysis. The reasonable MCID ranged from 12-14 points in the DASH and 12-15 points in the Quick DASH. FREE FULL TEXT

A 2024 systematic review assessed the effect of Kinesiotape (KT) for improving upper extremity (UE) function in children and adolescents with cerebral palsy (CP). 5 randomized controlled trials were included in the analysis. Improvement in upper extremity function with significant improvement in range of motion was demonstrated in 3 studies. Fine motor skills were improved in 2 studies, and 1 study showed improved grip strength, gross motor function, and spasticity. The study concluded that KT showed improvement in UE function. FREE FULL TEXT

A 2024 systematic review and meta-analysis investigated the quality of the evidence of the effect of the kinetic chain in non-athletes with shoulder pain. 6 cross-sectional studies involving 562 patients, of which 282 had shoulder pain, were included in the analysis. There was very low-quality evidence that shoulder pain may present with a lower active range of motion and muscular endurance and strength of the cervical spine, thoracolumbar spine, and hip. Cervical isometric strength did not differ between the shoulder pain and non-shoulder pain groups. The authors concluded that a broader physical assessment of the kinetic chain may be relevant for non-athlete shoulder pain patients. FREE FULL TEXT

A 2024 systematic review and meta-analysis assessed the effect of HILT on subacromial impingement syndrome. 5 RCTs and 1 controlled clinical trial (284 patients) were included in the analysis. Compared to conventional therapy, HILT showed significantly better outcomes. ABSTRACT

A 2024 systematic review and meta-analysis investigated the effect of combining acupuncture with physical therapy treatment for frozen shoulder syndrome. 13 studies were included in the analysis. Results indicated that the combined treatment approach significantly reduced pain and improved clinical effectiveness rates. Significant improvements were also observed in the active and passive range of motion, with varying degrees of heterogeneity. The authors concluded that the combination of acupuncture and physical therapy is more effective than physical therapy alone in managing pain, improving clinical effectiveness rates, and enhancing the range of motion in patients with frozen shoulders. ABSTRACT

A 2024 systematic review and meta-analysis assessed the effect of end-range manual therapy vs other conservative interventions on pain, range of motion (ROM), and physical function in adhesive capsulitis. 10 RCTs with 424 adult patients were included in the analysis. End-range mobilization showed improvements in pain, shoulder abduction, internal/external rotation, and physical function when compared to other conservative treatments. This was noted in both the short-term and medium-term for AC. It should be noted that the certainty of evidence was rated very low for all outcome measures. The authors recommended the use of manual therapy for adhesive capsulitis. ABSTRACT

A 2024 systematic review and meta-analysis evaluated the effect of TPMT on rotator cuff-related shoulder pain (RCRSP). 7 studies were included in the systematic review and 7 in the meta-analysis. Results showed no statistical difference in pain reduction in the short term, but shoulder function was statistically improved in TPMT compared to controls. TPMT of active trigger points of RCRP appears effective in the short-term (3 days-12 wks) for pain and more effective for functional improvement. TPMT may be recommended as part of a multimodal program for RCRSP. ABSTRACT

A 2024 systematic review and meta-analysis evaluated the effects of manual therapy (MT) on pain and functional improvement in the treatment of patients with rotator cuff injury (RCI). 24 RCTs with 1110 participants were included in the analysis. Results indicated that MT did not effectively relieve pain when compared to placebo. However, there was a limited impact on functional improvement. MT combined with exercise was significantly more effective than exercise alone for improvement in pain and function. Additional benefits were noted when MT was combined with multimodal physiotherapy. MT is, therefore, a pivotal component of the therapeutic intervention for RCI when combined with other therapies. FREE FULL TEXT

A 2024 systematic review and meta-analysis assessed the short-, intermediate-, and long-term effects of extracorporeal shockwave therapy (EST) on pain and shoulder function in rotator cuff tendinopathy patients. 9 studies with 543 participants were included in the analysis. Results indicated that EST was superior to sham EST in improving pain in the short term with a small effect size but not superior in the intermediate and long term. However, it was not successful in improving shoulder function at any point in follow-up. EST also failed to be superior to other treatments in improving shoulder pain and function. It appears that EST is mainly palliative in nature when treating rotator cuff tendinopathy. FREE FULL TEXT

A 2024 scoping review provided an overview of the evidence for best management (surgical and conservative) of partial thickness tear of the rotator cuff. 28 level 1 studies, 1 systematic review, 4 meta-analyses, and 1 network meta-analysis were included in the best evidence synthesis. Nonoperative strategies included exercise therapy and physical modalities. Operative interventions consisted of debridement, shaving of the tendon and footprint, trans-tendon repair, and suture anchor. The study revealed the the superiority of nonoperative management over surgical intervention, although both types of management resulted in decreased pain and improved functional outcomes. The study concluded that since surgery was more invasive and costly, with a higher risk of complication, conservative management should be considered as an option. ABSTRACT

A 2024 double-blinded randomized controlled trial of 33 patients with subacromial pain syndrome evaluated progressive scapular retraction exercises (SRE) and glenohumeral rotation exercises (GRE) for a scapular stabilization program over a 12-week supervised rehabilitation program that included exercise and manual therapy. Results indicated that progressive SRE and GRE lessened the symptoms and improved AHD in the subacromial pain syndrome patients to a greater degree than the group that had scapula stabilization exercise only. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated combined modalities vs exercise-only treatment of shoulder pain. 20 articles were included in the analysis. Therapeutic exercise was found to be the cornerstone of shoulder pain treatment, with laser therapy demonstrating substantial additional benefits. There was also some benefit to adding manual therapy and education, but these modalities did not show a great statistical benefit to exercise alone. FREE FULL TEXT

A 2024 systematic review and meta-analysis assessed the effect of exercise therapy (ET) with or without other adjunctive physical therapies when added to usual medical care (UMC) for adults with chronic shoulder pain. 54 studies involving 3893 participants followed up to 52 weeks were included in the analysis. Shoulder-specific exercises alone or in combination with electro-physical agents (PT), injections, or manual therapy were compared to usual medical care. Shoulder-specific exercises targeted the rotator cuff and scapular muscles. Physical therapy included TENS, ultrasound, laser, IFC, microwave diathermy, extracorporeal shockwave, thermotherapy, and dry needling. Manual therapy included soft tissue massage, joint mobilization, and ischemic trigger point compression. Injections included corticosteroid, prolotherapy, and platelet-rich plasma. Usual medical care included pharmaceutical therapy, information,n and recommendations. Results indicated that shoulder-specific ET provided pain relief up to 52 weeks; adding adjunct therapies added little value in reducing pain. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the effect of scapular stabilization exercises (SSE) on subacromial pain syndrome (SAPS). 8 randomized controlled trials involving 387 participants were included in the analysis. Results provide moderate support for SSE in reducing pain and improving function for SAPS, despite a lack of improvement in ROM. It is therefore recommended as part of conservative management in the initial treatment of SAPS. FREE FULL TEXT

A 2024 systematic review and meta-analysis investigated the short- and long-term outcomes of high-intensity (greater than 500mW) Laser Therapy (HILT). Although Low-Intensity Laser Therapy (LILT) has been shown to be more effective than placebo in the short term, the efficacy of HILT has conflicting results in the literature. Studies followed up for at least 4 weeks were included, with a total of 309 participants. HILT was compared to transcutaneous electrical stimulation (TENS), Low-Intensity Laser Therapy (LILT), and therapeutic exercise (TEX). Results showed moderate evidence for the efficacy of HILT compared to placebo, HILT + wrist splint, and exercise in a short period of follow-up time but evidence on long-term follow-up is limited. ABSTRACT

A 2024 systematic review assessed the effect of Kinesiotape (KT) for improving upper extremity (UE) function in children and adolescents with cerebral palsy (CP). 5 randomized controlled trials were included in the analysis. Improvement in upper extremity function with significant improvement in range of motion was demonstrated in 3 studies. Fine motor skills were improved in 2 studies, and 1 study showed improved grip strength, gross motor function, and spasticity. The study concluded that KT showed improvement in UE function. FREE FULL TEXT

A 2024 systematic review and meta-analysis assessed the short-, intermediate-, and long-term effects of extracorporeal shockwave therapy (EST) on pain and shoulder function in rotator cuff tendinopathy patients. 9 studies with 543 participants were included in the analysis. Results indicated that EST was superior to sham EST in improving pain in the short term with a small effect size but not superior in the intermediate and long term. However, it was not successful in improving shoulder function at any point in follow-up. EST also failed to be superior to other treatments in improving shoulder pain and function. It appears that EST is mainly palliative in nature when treating rotator cuff tendinopathy. FREE FULL TEXT

A 2024 scoping review provided an overview of the evidence for best management (surgical and conservative) of partial thickness tear of the rotator cuff. 28 level 1 studies, one systematic review, four meta-analyses, and one network meta-analysis were included in the best evidence synthesis. Nonoperative strategies included exercise therapy and physical modalities. Operative interventions consisted of debridement, shaving of the tendon and footprint, trans-tendon repair, and suture anchor. The study revealed the superiority of nonoperative management over surgical intervention, although both types of management resulted in decreased pain and improved functional outcomes. The study concluded that since surgery was more invasive and costly, with a higher risk of complication, conservative management should be considered as an option. ABSTRACT

A 2024 double-blinded randomized controlled trial of 33 patients with subacromial pain syndrome evaluated progressive scapular retraction exercises (SRE) and glenohumeral rotation exercises (GRE) for a scapular stabilization program over a 12-week supervised rehabilitation program that included exercise and manual therapy. Results indicated that progressive SRE and GRE lessened the symptoms and improved AHD in the subacromial pain syndrome patients to a greater degree than the group that had scapula stabilization exercise only. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated combined modalities vs exercise-only treatment of shoulder pain. 20 articles were included in the analysis. Therapeutic exercise was found to be the cornerstone of shoulder pain treatment, with laser therapy demonstrating substantial additional benefits. There was also some benefit to adding manual therapy and education, but these modalities did not show a great statistical benefit to exercise alone. FREE FULL TEXT

A 2024 systematic review and meta-analysis assessed the effect of exercise therapy (ET) with or without other adjunctive physical therapies when added to usual medical care (UMC) for adults with chronic shoulder pain. 54 studies involving 3893 participants followed up to 52 weeks were included in the analysis. Shoulder-specific exercises alone or in combination with electro-physical agents (PT), injections, or manual therapy were compared to usual medical care. Shoulder-specific exercises targeted the rotator cuff and scapular muscles. Physical therapy included TENS, ultrasound, laser, IFC, microwave diathermy, extracorporeal shockwave, thermotherapy, and dry needling. Manual therapy included soft tissue massage, joint mobilization, and ischemic trigger point compression. Injections included corticosteroids, prolotherapy, and platelet-rich plasma. Usual medical care included pharmaceutical therapy, information, and recommendations. Results indicated that shoulder-specific ET provided pain relief for up to 52 weeks; adding adjunct therapies added little value in reducing pain. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the effect of scapular stabilization exercises (SSE) on subacromial pain syndrome (SAPS). 8 randomized controlled trials involving 387 participants were included in the analysis. Results provide moderate support for SSE in reducing pain and improving SAPS function despite a lack of improvement in ROM. It is therefore recommended as part of conservative management in the initial treatment of SAPS. FREE FULL TEXT

A 2023 systematic review evaluated the effect of exercise on massive rotator cuff tear (MRCT)injuries. Randomized and non-randomized trials were include, as well as case series and cohort studies, with serious to moderate risk of bias. The authors concluded that there is limited evidence that exercise is effective in the management of MRCT. ABSTRACT

A 2023 systematic review and meta-analysis investigated the effects of Extracorporeal Shock Wave Therapy (ESWT) on non-calcific rotator cuff tendinopathy. 9 studies were included, with a total of 534 patients. Results indicated that ESWT was superior to sham in improving pain intensity in the short term but not in the long term. ESWT also was not superior to other treatments in pain management in the short or intermediate term. ESWT did not improve shoulder function. The study concluded that only a small improvement in shoulder pain was provided with ESWT in the short term. ABSTRACT

A 2023 systematic review assessed the effect of diet, exercise, and sleep disorder treatment for chronic shoulder pain. 17 articles were included. Results confirmed that exercise generates a hypoalgesia effect that improves pain, functionality, and quality of life. There was a lack of evidence that diet or sleep influenced chronic shoulder pain. FREE FULL TEXT

A 2023 systematic review and meta-analysis investigated the effect of manual therapy (MT) with exercise therapy for rotator cuff 12 articles were included; most were of high methodological quality. Results showed that there was no significant difference in pain or shoulder function between the MT & exercise group and the exercise alone group. The authors concluded that adding MT to exercise for rotator cuff pain was not more effective than exercise alone. ABSTRACT

A 2023 systematic review and meta-analysis investigated the effect of end-range mobilization on adhesive capsulitis. 10 RCTs were included, with a total of 424 patients. Outcomes measured included pain, range of motion, and physical function. All outcomes were improved using grade 4 mobilization of the glenohumeral joint when compared to other conservative interventions for both short and medium-term follow-ups. The authors concluded that very low certainty evidence suggests that end-range mobilization techniques improve pain intensity, shoulder ROM, and physical function in the short and medium term in adhesive capsulitis. ABSTRACT

A 2023 systematic review and meta-analysis assessed the effectiveness and safety of dry needling with electrical stimulation (DNES) for musculoskeletal shoulder pain. DNES was examined with and without conventional physical therapy (CPT). 5 RCTs were included. Although pain was improved, the difference between groups was not statistically significant. The authors concluded that DNES did not provide significant improvement in pain or disability compared to CPT alone. FREE FULL TEXT

A 2023 systematic review and meta-analysis assessed the effect of scapular mobilization on range of motion (ROM) and pain intensity in primary adhesive capsulitis. 6 trials were included. No studies found significant benefits of scapular mobilization on ROM, disability, or pain intensity compared with other manual therapies or other treatments, although the quality of the evidence was very low. FREE FULL TEXT

A 2023 systematic review and meta-analysis investigated the effect of injection of hyaluronic acid (HA) as a nonsurgical treatment for shoulder OA. 15 studies with a total of 1023 patients were included in the meta-analysis. Comparisons included physical therapy alone or combined with the injection. Results indicated that HA injections might be effective for pain relief. FREE FULL TEXT

A 2023 RCT investigated the effect of Mulligan mobilization with movement (MWM) and muscle energy technique (MET) on 45 patients with lateral elbow tendinopathy (LET), compared with a control group receiving home exercise only. Results indicated that both MWM and MET showed greater improvement in all outcomes compared to the control group. There was no significant difference between the 2 techniques. The authors concluded that MWM and MET, used in addition to home exercises, can be beneficial in alleviating pain and increasing grip strength, finger strength, and functionality. FULL TEXT

A 2023 systematic review of RCTs assessed the effect of manipulative therapy on patients with lateral epicondylitis. Four studies were included in the analysis. Results indicated that wrist manipulation over 3 weeks post-treatment was superior to any of the comparison treatments (ultrasound, laser therapy, friction massage, and exercises). ABSTRACT

A 2023 systematic review and meta-analysis of RCTs evaluated the efficacy of high-intensity laser therapy versus other different modalities for improving lateral epicondylitis symptoms. Six RCTs with 344 patients were included in the analysis. Results indicated low-quality evidence that high-intensity laser therapy reduces pain intensity compared to control during activity and during rest. Low-quality evidence indicated that high-intensity laser therapy improves the physical component of quality of life compared with control. The authors concluded that although laser therapy is effective for pain reduction and improved physical quality of life, grip strength, hand function, and general quality of life did not show significant differences between high-intensity laser therapy and other therapies. ABSTRACT

• A 2022 systematic review and meta-analysis evaluated the additional benefits of manual therapy (MT) when added to exercise for rotator cuff-related shoulder pain (RCRSP). 12 randomized controlled trials were included. Outcomes were pain with movement, pain at rest, and shoulder function. The authors concluded that adding MT to an exercise intervention was not more effective than exercise alone in managing RCRSP in adults. ABSTRACT
• A 2022 systematic review and meta-analysis assessed the effects of mobilization with movement (MWM) for musculoskeletal shoulder disorders. 21 studies were included in the analyses. For both frozen shoulder and shoulder pain with movement dysfunction, the addition of MWM significantly improved pain, flexion ROM, abduction ROM, and disability. The majority of studies were found to have a high risk of bias. ABSTRACT
• A 2022 randomized controlled trial of 75 patients with shoulder impingement syndrome (SIP) investigated the effect of muscle energy technique (MET) applied to the thoracic spine on pain and disability in SIP. Each of the 3 groups received either MET, MET, and soft tissue massage or a placebo. There was a significant improvement in pain and disability in the MET-only group, while the MET+soft tissue massage group showed improvement in disability but not pain. The authors concluded that MET of the thoracic spine, with or without soft tissue massage, improved pain and disability in shoulder impingement syndrome. FREE FULL TEXT

A 2022 randomized controlled trial (RCT) with 46 patients with elbow tendinopathy evaluated the effect of low-load resistance training (LLRT) with blood flow restriction (BFR) as compared to an LLRT with a sham BFR. Patients performed the exercise 2/week for 6 weeks and were followed up through 12 weeks. Results indicated that the intervention group had superior improvement over the control group in all outcomes. The authors concluded that LLRT with BFR may improve recovery from elbow tendinopathy. ABSTRACT

• A 2022 systematic review and meta-analysis evaluated the effect of high-intensity laser therapy (HILT) on symptoms of lateral epicondylitis. 6 RCTs were included, with a total of 344 patients. Results indicated that there is low-quality evidence that HILT (>500mW) provided a small reduction in pain intensity compared to a control group. The authors concluded that HILT was effective in reducing pain and improving quality of life. However, compared to other therapies did not show a significant difference in grip strength, hand function, or quality of life. ABSTRACT
• A 2022 randomized controlled trial investigated the effects of neuromobilization techniques compared to conservative rehabilitation on pain, grip strength, and functional status in 40 patients with lateral epicondylitis (LE). Results showed a significant decrease in all pain scores in favor of the neuromobilization group at week. No significant differences were found for grip strength, pinch strength, joint motions, and functional level in the neuromobilization group, although trends toward better improvement were observed. The authors concluded that radial nerve mobilization techniques are more effective on pain than conservative rehabilitation therapy. ABSTRACT
• A 2022 systematic review assessed the effect of physical therapy on lateral epicondylitis. 19 articles were included, of which 7 applied shock waves, 3 orthoses, 3 manual therapy techniques, 2 bandaging, 1 therapeutic exercise, 1 diacutaneous fibrolysis, 1 high-intensity laser, and 1 vibration. Results showed that manual therapy and eccentric strength training had the greatest beneficial effects, as well as a favorable cost-benefit ratio. FREE FULL TEXT

• A 2021 systematic review evaluated conservative care for carpal tunnel syndrome. Interventions included drugs, electrotherapy of various types, and/or manual therapy. Both electrotherapy (shock wave, ultrasound, laser, electroacupuncture, diathermy, and radiofrequency) and manual therapy showed significant improvement in function over the controls as measured by the Boston Carpal Tunnel Questionnaire. Oral corticosteroids reduced edema in the carpal tunnel and were effective for 3 months post-treatment. Most studies have a combination of treatments and few studies evaluated the long-term outcomes. It appears that a combination of pharmacological and nonpharmacological treatments is useful in the short term. FREE FULL TEXT
• A 2021 systematic review assessed the efficacy of various physiotherapy treatments for lateral epicondylitis. Nineteen articles were included that applied shock waves, orthosis, manual therapy techniques, bandage, therapeutic exercise, high-intensity laser, vibration, or diacutaneous fibrinolysis. The greatest beneficial effects were found with manual therapy and eccentric strength training. This also provided the best cost-benefit ratio. When these therapies are combined with the other therapies it facilitates the therapeutic goals but also increases cost. FREE FULL TEXT

A 2017 review⁶ evaluating passive modalities for common soft tissue elbow conditions found 8 RCTs with a low risk of bias. All studies assessed treatments for lateral epicondylitis (LE).

• For LE of variable duration:
  • TENS did not provide benefit when added to primary care management
  • Evidence is inconclusive for elbow braces as they fared similarly to other interventions such as multimodal PT (ultrasound, massage and exercise) or no intervention.
• For persistent LE:
  • Evidence is inconclusive for shockwave therapy when compared to placebo and low-level laser therapy

• A 2021 systematic review and meta-analysis evaluated the role of joint hypermobility in relation to shoulder injuries in athletes. It found that athletes with joint hypermobility (shoulder hypermobility, ligament laxity or instability) were 3X more likely to have shoulder injuries than those without hypermobility. Injuries included traumatic dislocation, instability, or subluxation. FREE FULL TEXT
• A 2021 systematic review and meta-analysis evaluated the effects of trigger point dry needling on pain intensity and disability in nontraumatic shoulder pain. There was moderate-quality evidence that this therapy reduced shoulder pain intensity in the short term when compared to a comparison group. ABSTRACT
• A 2021 systematic review evaluated conservative care for carpal tunnel syndrome. Interventions included drugs, electrotherapy of various types, and/or manual therapy. Both electrotherapy (shock wave, ultrasound, laser, electroacupuncture, diathermy, and radiofrequency) and manual therapy showed significant improvement in function over the controls as measured by the Boston Carpal Tunnel Questionnaire. Oral corticosteroids reduced edema in the carpal tunnel and was effective for 3 months post-treatment. Most studies have a combination of treatments and few studies evaluated the long term outcomes. It appears that a combination of pharmacological and nonpharmacological treatments is useful in the short term. FREE FULL TEXT
• A 2021 systematic review evaluated physical therapy treatments for adhesive capsulitis. The interventions included acupuncture, cryo-therapy, mobilization, shock wave, stretching PNF, laser, ultrasound, exercise, manual therapies and others. All therapies improved pain scores, but only whole body cryotherapy, Mulligan mobilization, shock wave stretching, continuous passive motion, rotator cuff strengthening, and lidocaine injection or nerve block in conjunction with physical therapy demonstrated significant group differences. Some therapies were found to have higher quality of evidence for improvement in pain levels while others were found to improve ranges of motion. FREE FULL TEXT

A 2020 umbrella review (a review of systematic reviews) evaluated the effectiveness of physical therapy interventions, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches, for managing subacromial shoulder pain. It made a strong recommendation for exercise therapy as the first-line treatment with manual therapy integrated as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound. FREE FULL TEXT

A 2020 systematic review evaluated the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain. It concluded that IC technique seems to be beneficial for pain and shoulder function.⁶ ABSTRACT 

• A 2020 systematic review assessed the role of joint mobilization for individuals with carpal tunnel syndrome (CTS). It concluded that joint mobilization was associated with positive clinical effects for persons with CTS. No studies used joint mobilization in isolation; therefore, results must be interpreted cautiously. This review indicates that joint mobilization might be a useful adjunctive intervention in the management of CTS. ABSTRACT
• A 2020 systematic review assessed the effectiveness of acupuncture and related therapies for primary carpal tunnel syndrome (CTS). Although the evidence was limited, it concluded that for both symptom relief and function improvement, manual acupuncture is superior to ibuprofen while electroacupuncture plus splinting outperforms splinting alone. ABSTRACT
• A 2020 RCT evaluated the effects of acupressure on severity, function and electrodiagnostic findings in 57 patients with carpal tunnel syndrome (CTS). There were three groups: acupressure, placebo acupressure, and standard care. Results showed significant differences in the mean severity of symptoms, hand function and electrodiagnostics before and after the intervention in the acupressure group. The authors concluded that acupressure was effective in reducing the severity of clinical symptoms, improving the hand function, and improving the electrodiagnostic findings. ABSTRACT
• A randomized controlled trial with a 4-year follow-up evaluated the benefits of manual nerve gliding techniques and compared this to surgical treatment for carpal tunnel syndrome. In the long term, manual therapy, including desensitization maneuvers of the central nervous system, resulted in similar outcomes and similar surgery rates compared with surgery in women with CTS. Both interventions were combined with a tendon/nerve gliding exercise program at home.  FREE FULL TEXT
• A 2020 double-blinded randomized controlled trial of the effect of self-myofascial stretching of the carpal ligament was evaluated via symptom outcomes and nerve conduction studies on carpal tunnel syndrome patients. Results showed a statistically significant improvement in symptoms. FREE FULL TEXT

A 2020 case series used an innovative magnetic resonance technique (T_1p) to evaluate elbow pain. Patients were treated with fascial manipulation with imaging taken before and after treatment and the patients were monitored with use of the DASH outcome measure. The results suggest that the application of a fascial manipulation manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients.This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies and explain the source of the mechanisms of pain. FREE FULL TEXT