Do exercises work as well as injection for shoulder pain from shoulder impingement?

This is a question new patients with shoulder pain ask me regularly following the suggestion of a steroid injection from either their GP or consultant. They often make an appointment with me in the hope that they can avoid having an injection.

Anecdotally the use of steroid injections has become less prevalent during the course of my career, and more and more doctors and surgeons prefer to try a course of physiotherapy before injection.

There are still plenty of patients who haven’t been given any advice on rehabilitation of hands on physiotherapy to try and alleviate their symptoms though.

Littlewood et al. reviewed the effectiveness of conservative intervention for ‘rotator cuff tendinopathy’ All patients had a clinical diagnosis of shoulder impingement syndrome (SIS) symptoms. The authors found exercise is superior to placebo and no treatment, and surgery did not add benefit over exercise alone. Most other things have conflicting / no evidence to support – eg steroid injections, manual therapy, shockwave, etc.

All in all this appears to be a very positive review for exercise based therapy in the treatment of a broad spectrum of SIS associated pathologies involved in shoulder pain.

If you or anyone you know is suffering from shoulder pain and would like to have a physiotherapy assessment for suitability of physiotherapy treatment, contact us here.

Development of a self managed loaded exercise programme for rotator cuff tendinopathy, Littlewood et al, shoulder and  elbow vol 5, issue 3.

Exercise for rotator cuff tendinopathy: a systematic review, Littlewood et al, Physiotherapy, Volume 98, Issue 2, June 2012, Pages 101–109