Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: A systematic review and meta-analysis.
tl:dr
Participants that had shoulder pain with resistance or end range passive motion (determined via various special tests) used scapular focused interventions and had a significant decrease in pain, increase in shoulder function, and increase in range of motion within 4 weeks.
The full story:
One of the most common causes of shoulder pain is subacromial pain syndrome (otherwise known as SAPS). SAPS is an umbrella term that includes general bursitis, biceps tendinitis, supraspinatus tendinopathy, calcific tendinitis, partial rotator cuff tears, and tendon cuff degeneration. Some of these may or may not be caused by impingement, a word that you’ve likely heard before when your co-worker or workout buddy said “Definitely sounds like impingement, man” when you told him about your shoulder pain.
What he didn’t know as he gave you his scientific opinion is that there does not seem to be solid correlation of acromiohumeral distance to symptom severity (Balke et al., 2013; Gill et al., 2002; Michener et al., 2015; Moor et al., 2014; Worland et al., 2003; Yi et al., 2015).
Furthermore, surgery is not any more effective than more conservative approaches (like rehabilitative exercises) for symptom management of this type of shoulder pain (Dong et al., 2015; Page et al., 2016).
Essentially, the origin of the pain can be from a variety of different sources, not just impingement. So if that’s the case, does the source then matter?
It may not.
This research combed over many randomized controlled trials in which people had SAPS and used scapular focused training exercises for interventions and compared them to a variety of other interventions. This eventually came to include 250 people, ranging in age from 18 to 65 years old. It is important to note that no rotator cuff exercises were performed in the trials.
What they found was that just using scapular exercises, the participants had a significant reduction in shoulder pain as well as improvement in shoulder function in only 4 weeks.
Scapular exercises included exercises and mobilizations of upper, mid, and lower traps, rhomboids, serratus anterior, and levator scapula –they did not include rotator cuff exercises. However, once the participants stopped the program, there was no longer a significant difference in pain and function compared to a control group after another 4 weeks. This highlights a couple things.
First, because the shoulder pain was defined as sub acromial pain syndrome (an umbrella term for many different diagnoses of shoulder pain), we can conclude that regardless of the exact physiologic pathology, pain, function, and motion can improve with only scapular based interventions. In fact, many of the interventions that were compared against the scapular based exercises were physical therapy mobilizations, rotator cuff exercises, modalities, and flexibility exercises – and the pooled data showed significantly better results with scapular based interventions.
This is important because, at least anecdotally, it seems that too much emphasis is placed on the rotator cuff for shoulder health at the behest of other vital body structures. This evidence may suggest that adding scapular based exercises with other exercises, like rotator cuff interventions, would improve function, pain, and range of motion greater than either alone.
Lastly, this shows that either longer duration programs are needed to maintain a permanent change or a maintenance phase should be performed. Since significant changes were found after only 4 weeks, it’s good news for those that want to feel better faster. However, the changes didn’t last if the programs were stopped. So either the programs need to be more thorough in the duration, scope, and pain reduction or they need to include a maintenance phase for those individuals happy with their progress after only 4 weeks. Luckily, you find all of these elements with the Renegade Rehab Shoulder Programs.