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Many studies have been conducted over the years correlating exercise with recovery from injury. Physical therapy is a vital step in recovery for many patients dealing with musculoskeletal injuries to help them restore functionality and quality of life. Now, a new study from researchers in Switzerland and Belgium has found, after testing exercise with other non-exercise physical therapy methods, that exercise is the superior mode of treatment for patients with shoulder impingement syndrome.

Shoulder impingement syndrome, also known as swimmer’s shoulder, includes any kind of injury to structures in the subacromial space of the shoulder, including rotator cuff tendonitis, partial-thickness tears of the rotator cuff, and bursitis. It is a common cause of shoulder pain that occurs when bones in the shoulder rub against tendons and cause inflammation. Risk factors include overuse of the shoulder from activities like swimming and lifting, bone and joint abnormalities, and ageing. Over time, the pain from shoulder impingement can become debilitating, interfering with everyday activities involving use of the arm. If not treated promptly, the rotator cuff tendons can thin and tear, resulting in a rotator cuff tear that severely limits movement.

Before this study, exercise was traditionally recommended as a supplement to anti-inflammatory medications. Doctors may refer patients to a physical therapist to demonstrate exercises they can do to stretch and strengthen the shoulder muscles. The findings of this study are significant because they confirm and augment the importance of exercise in shoulder impingement syndrome treatment. The researchers acknowledge that the evidence that came out of the study is low-quality; however, after a review and analysis of 200 trials comparing conservative strategies to treat shoulder impingement, they are confident that exercise is an effective treatment and should be the primary mode of treatment prescribed by doctors.

“Although the quality of evidence is overall very low, we are confident that exercise is effective in improving pain, function and active range of motion in patients with shoulder impingement. Therefore, clinicians should use exercise as the first treatment,” co-author Roger Hilfiker of the School of Health Sciences in Switzerland reported to Reuters.

Other commonly-prescribed treatments for shoulder impingement syndrome can and still should be administered, the authors state, but as a supplement to exercise. These include corticosteroid injections, manual therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), tape, Extracorporeal Shock Wave Therapy (ESWT), and laser therapy.

The study looked at the use of other therapies in combination with exercise as well, such as massage, pulsed electromagnetic fields, transcutaneous electrical nerve stimulation, and comprehensive physiotherapy, which all had inconclusive results.

As Hutchinson concluded, the results of this study are not necessarily practice-changing as they would have been more significant if the lower-quality studies were excluded from the meta-analysis. Nonetheless, they are important for confirming the importance of exercise over other treatments and doing nothing.