Exercise best for shoulder pain

By Jane Collingwood
Exercises can be more effective for patients with shoulder pain than shock-wave treatment, researchers report today.

The shoulder is a common site for musculoskeletal pain. It is often labelled as subacromial shoulder pain, rotator cuff disease, impingement syndrome, or rotator cuff tendinosis.

Its cause is often unclear, and patients are treated with non-steroidal inflammatory drugs, corticosteroid injections, and physiotherapy including radial extracorporeal shockwave treatment.

Dr Kaia Engebretsen of the University of Oslo, Norway, and colleagues explain that several previous studies indicate that shockwave treatment may not be effective, but it is still widely used.

To compare the effectiveness of this treatment compared with supervised exercises they recruited 104 adult men and women who had suffered shoulder pain for at least three months. Patients received either one shockwave treatment session per week for four to six weeks, or two 45 minute sessions of supervised exercises weekly for up to 12 weeks.

Results were better for the supervised exercises at six, 12, and 18 weeks, the team reports on the website of the British Medical Journal.

"A significantly higher proportion of patients in the group treated with supervised exercises improved," the team writes.

They add that more patients in the exercise group were able to return to work, and more patients in the shockwave treatment group needed additional treatment between 12 and 18 weeks.

They conclude: "Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain."

Engebretsen, K. et al. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. The British Medical Journal 2009;339:b3360.