Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain

A review paper from researchers at department of physiotherapy, University of Sydney examined  the effectiveness of exercise and soft tissue massage either in isolation or in combination for the treatment of non-specific shoulder problems. “Nonspecific shoulder pain” refers to shoulder pain without a clear pathology or physical signs. The review was published in the British Journal of Sports Medicine.

The authors searched database for articles from 1966 to December 2011. Studies were eligible if they investigated ‘hands on’ soft tissue massage performed locally to the shoulder or exercises aimed at improving strength, range of motion or coordination; non-surgical painful shoulder disorders; included participants aged 18-80 years and outcomes measured included pain, disability, range of motion, quality of life, work status, global perceived effect, adverse events or recurrence.

There were twenty-three papers met the selection criteria representing 20 individual trials. The authors found low-quality evidence that soft tissue massage was effective for producing moderate improvements in active flexion and abduction range of motion, pain and functional scores compared with no treatment, immediately after the cessation of treatment. Exercise was shown by meta-analysis to produce greater improvements than placebo, minimal or no treatment in reported pain but these changes were of a magnitude that was less than that considered clinically worthwhile. Exercise did not produce greater improvements in shoulder function than placebo, minimal or no treatment.

The takeaway message can be found in one study that showed the greatest treatment effect for massage. The authors wrote: “The greatest improvements with soft tissue massage [were found with] targeted treatment towards the lateral border of the scapula in end-range flexion, the posterior deltoid region in end-of-range horizontal flexion, anterior deltoid in end-of-range external rotation (measured as hand behind back) and pectoralis major in the stretch position. This demonstrated moderate improvements in active flexion and abduction ranges of motion, pain levels and functional scores.”

The researchers also conclude that there is evidence that soft-tissue massage is effective for improving external rotation range of motion in patients with adhesive capsulitis. The authors emphasize that soft-tissue massage techniques should be considered an important form of therapy, and they encourage future researchers to describe the massage techniques used in their studies in more detail.