Open Access

Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis

  • Authors:
    • Shuang Liu
    • Lin Chen
    • Qi Shi
    • Yide Fang
    • Weiwei Da
    • Chunchun Xue
    • Xiaofeng Li
  • View Affiliations

  • Published online on: April 11, 2024     https://doi.org/10.3892/br.2024.1778
  • Article Number: 89
  • Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

To critically evaluate the effects of manual therapy (MT) on pain and functional improvement in patients with rotator cuff injury (RCI), a systematic review of all randomized controlled trials (RCTs) on MT for RCI was conducted in the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Physiotherapy Evidence Database, Chinese National Knowledge Infrastructure, Wan‑fang Data, Chinese Scientific Journal Database, and Chinese Biomedical Literature database from inception to March 28, 2023. A total of 1,110 participants from 24 eligible RCTs were included in the analysis. Compared with placebo, MT could not effectively relieve pain [standardized mean difference (SMD)=‑0.25; 95% CI: ‑0.51 to 0.01; P=0.06], although its impact on functional improvement appears limited (SMD=0.20; 95% CI: ‑0.09 to 0.49; P=0.18). Combining MT with exercise had significant advantages over exercise alone, as combined therapy contributed to both pain reduction (SMD=0.36; 95% CI: 0.08 to 0.64; P=0.01) and functional enhancement (SMD=0.32; 95% CI: 0.11 to 0.52; P=0.002). Furthermore, MT combined with multimodal physiotherapy showed additional benefits in pain reduction (mean difference=1.57; 95% CI: 0.18 to 2.96; P=0.03) and functional improvement (SMD=0.77; 95% CI: 0.43 to 1.12; P<0.0001) compared with multimodal physiotherapy alone. These findings highlight the superior pain alleviation and functional improvement provided by MT when combined with exercise or physiotherapy. Consequently, MT has emerged as a pivotal component of therapeutic intervention for RCI.

Introduction

Rotator cuff injury (RCI) encompasses various shoulder disorders affecting the rotator cuff, including tears, tendinitis and impingement syndrome (1). Patients with RCI commonly report shoulder pain during specific movements and experience functional limitations (2,3), leading to sleep disturbance, stress and disruptions to daily and professional activities (4-6). Therefore, effective treatment is crucial to alleviate discomfort and enhance the quality of life of patients with RCI.

Treatment options for RCI include surgery (2), exercise, manual therapy (MT), physiotherapy, nonsteroidal anti-inflammatory drugs, intra-articular glucocorticoid injections and therapy using biomaterials (7-13). Surgery can restore the anatomy of rotator cuff well, but there is still a certain rate of retear (7). Non-steroidal anti-inflammatory drugs and intra-articular glucocorticoid injection can relieve pain in a short period of time, but the improvement of function is limited (7,8). Although biomaterials have made great progress in promoting the repair of RCI (9-13), they have not been widely used in clinical practice. MT is widely used as a non-pharmacological intervention by physiotherapists, chiropractors and osteopaths. MT involves the manipulation of joints and surrounding tissues by healthcare professionals. In the clinical setting, MT is administered either alone or in conjunction with exercise therapy or multimodal physiotherapy.

While previous systematic reviews and meta-analyses have assessed the efficacy of MT for RCI (14-16), these analyses often conducted qualitative syntheses of outcomes such as functional scores without pooling results into meta-analyses. Additionally, the effectiveness of MT in isolation, as well as its supplementary benefits when combined with exercise or physiotherapy, remain unclarified.

Previous randomized controlled trials (RCTs) have suggested that MT, alone or in combination with exercise or multimodal physiotherapy, yields positive outcomes for RCI (17-25). To provide a comprehensive overview, an updated systematic review and meta-analysis was conducted to evaluate the effectiveness of MT, either alone or as part of a multimodal intervention, on pain and function in patients with RCI.

Materials and methods

Data sources/searches

The registration number of the present systematic review in PROSPERO database is CRD42021246202 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=246202). The present study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses statement (26). The following electronic databases were searched from their date of inception to March 28, 2023: PubMed (https://pubmed.ncbi.nlm.nih.gov), Cochrane Central Register of Controlled Trials (https://www.cochranelibrary.com), Embase (https://www.embase.com/), Web of Science (https://www.webofscience.com), Physiotherapy Evidence Database (PEDro) (https://pedro.org.au), Chinese National Knowledge Infrastructure (https://www.cnki.net), Wan-fang Data (https://www.wanfangdata.com.cn/), Chinese Scientific Journal Database (http://qikan.cqvip.com/index.html) and Chinese Biomedical Literature database (http://www.sinomed.ac.cn/index.jsp). A combination of MESH terms and text words was used to identify relevant articles. These search terms were translated into Chinese for use in searching the aforementioned Chinese databases. Additionally, the reference lists of identified studies were screened to ensure that no relevant studies were overlooked. The complete PubMed search strategy is presented in Table SI.

Study selection

Inclusion criteria. Two investigators independently screened the studies by reading the titles, abstracts and complete texts. The inclusion criteria were: i) participants aged ≥18 years diagnosed with RCI, including rotator cuff tendinopathy/tendinitis, shoulder impingement syndrome, or subacromial bursitis, regardless of sex; ii) interventions comparing MT vs. placebo, MT plus exercise vs. exercise alone, or MT plus multimodal physiotherapy vs. multimodal physiotherapy alone; iii) outcomes broadly categorized into pain and shoulder function scores, with no restrictions; iv) RCT design and v) publication in English or Chinese.

Exclusion criteria

The exclusion criteria were: i) inability to locate a summary or full text; ii) studies from which data could not be accurately extracted; and iii) inconsistent outcome indicators. For republished studies, the most comprehensive reported data with the longest follow-up were selected.

Data extraction

The following data were independently extracted by two reviewers: first author, publication year, study characteristics (sample size, age, interventions, and intervention dosage and frequency), quality assessment details (randomization, allocation concealment, blinding, and outcome reporting), and study results. Data were cross-checked by two reviewers; in cases of disagreement, a third reviewer participated in discussions until a consensus was reached.

Outcome definitions

Outcome measures included shoulder pain and functional scores. Pain was assessed using the visual analogue scale, numeric pain rating scale, and pain component of composite scales. Functional scores comprised the Disability of the Arm, Shoulder and Hand Score, Shoulder Pain and Disability Index, Constant-Murley Score and Pennsylvania Shoulder Score. Due to limited long-term follow-up after the end of treatment in most studies, only data obtained at the end of treatment were included in the meta-analysis. A descriptive analysis was performed for studies with long-term follow-up (the follow-up period was >1 year).

Quality assessments

The risk of bias in included trials was assessed using items 2-11 of the PEDro scale, which gives a total score of 10(27) (Table I). The PEDro scale has favorable reliability and validity (28-30) and is commonly used in systematic reviews of physiotherapy efficacy (31-33). Trials scoring ≥6 out of 10 were considered to have a low risk of bias (34,35). The risk of bias was independently evaluated by two reviewers.

Table I

Physiotherapy evidence database scale.

Table I

Physiotherapy evidence database scale.

ItemCriteria
1Eligibility criteria were specified
2Subjects were randomly allocated to groups
3Allocation was concealed
4Group were similar at baseline for the most important prognostic indicators
5All participants were blinded
6All participants who administered therapy were blinded
7All assessors who measured at least one key outcome were blinded
8Measures of at least one key outcome measures were obtained from more than 85% of the participants initially allocated to groups
9All participants for whom outcome measures were available received the treatment or control condition as allocated, or, where this was not the case, data for a least one key outcome was analyzed by intention to treat
10The results of between group statistical analysis are reported for at least one key outcome
11The study provides both point measures and measures of variability for at least one key outcome.
Statistical analysis

Meta-analysis was conducted by calculating effect sizes and 95% confidence intervals in Review Manager 5.4 (Cochrane Collaboration; https://www.cochrane.org/). Results were organized based on outcome measures and intervention types. Numerical variables were analyzed using the mean difference (MD) or standardized MD (SMD). Pre- to post-treatment changes in pain and functional scores were pooled. In studies with crossover designs, outcome measures were analyzed at the first intervention exchange. Subgroup analysis was performed based on intervention dosage or frequency discrepancies.

Statistical heterogeneity was assessed using the I2 statistic and the chi-squared test. If I2≤50% and P≤0.05, the heterogeneity between studies was considered acceptable (36). If there was significant heterogeneity (I2>50% and P<0.05) (37), the source of heterogeneity was explored by one-by-one exclusion sensitivity analysis. Because the included studies were from different study populations, a random effects model was used in all meta-analyses. P<0.05 was considered to indicate a statistically significant difference.

Results

A total of 4,774 articles were retrieved from the online databases. Among these, 1,907 articles were excluded due to duplication, while another 2,788 articles were excluded after independent screening of titles and abstracts by two reviewers. A total of 24 studies (38-52) met the inclusion criteria and were included in the quantitative synthesis after full-text review. No republished studies were reviewed. A detailed depiction of the literature screening process is provided (Fig. 1).

Basic characteristics of included studies

The characteristics of the included trials are summarized in Table II. A total of 24 eligible RCTs evaluated the efficacy of MT for RCI, involving 1,110 participants (546 in the experimental group, 564 in the control group). All studies included adults >18 years of age, and only one study (24) restricted the age range to young adults between 18-35 years of age. Among these RCTs, 10 compared MT with placebo, 11 evaluated the additional efficacy of MT added to exercise therapy vs. exercise alone, and three assessed the additional benefit of MT combined with multimodal physiotherapy vs. multimodal physiotherapy alone.

Table II

Characteristics of the included studies.

Table II

Characteristics of the included studies.

Manual therapy vs. placebo
Author, yearDiagnosisSample size (Exp/Ctr)Age (Exp/Ctr)Intervention (Exp/Ctr)FrequencyTreatment durationFollow-up periodOutcome(Refs.)
Atkinson et al, 2008Rotator cuff tendinopathy30/3041.53 (18-63)/42 (20-76)MT/Placebo6 sessions in 2 weeks2 weeks2 weeks(38)
Aytar et al, 2015Subacromial impingement syndrome22/2252±3/52±4MT/Placebo9 sessions in 3 weeks3 weeks11 weeks①④(39)
Silva et al, 2019Rotator cuff30/30 46.06±16.11/44.46±12.14MT/PlaceboOnly once//(25)
Delgado-Gil et al, 2015Shoulder impingement syndrome21/21 55.4±7.8/54.3±10MT/Placebo2 sessions per week2 weeks2 weeks(40)
Guimarães et al, 2016Shoulder impingement syndrome14/13 30.3±6.9/31.9±9.2MT/Placebo4 treatments (48 h apart)8 days8 days②⑤(41)
Haik et al, 2017Shoulder impingement syndrome30/31 32.5±12.0/31.3±11.0MT/Placebotwice in a period of 3-4 days apart3-4 days1 week②④(42)
Hunter et al, 2022Shoulder impingement syndrome25/25 62.0±9.6/61.4±11.3MT/Placeboonce a week4 weeks12 months①④(20)
Kardouni et al, 2015Subacromial impingement syndrome24/21 31.1±12.3/31.2±12.1MT/PlaceboOnly once//②⑥(43)
McClatchie et al, 2009Painful arc7/1449.8±9.8MT/PlaceboOnly once//(44)
Surenkok et al, 2009Rotator cuff tendinitis or tenosynovitis13/13 55.07±13.36/54.30±12.70MT/PlaceboOnly once//①⑦(45)
Manual therapy plus exercise vs. exercise alone
Akbaba et al, 2019Rotator cuff pathology20/21 50±11.23/54.1±9.34MT+Ex/ExMT: twice a week; Ex: twice a day6 weeks6 weeks①④(17)
Bang and Deyle, 2000Shoulder impingement syndrome27/2342±10.1/45±8.4MT+Ex/ExTwice a week3 weeks3 weeks(46)
Camargo et al, 2015Shoulder Impingement23/23 35.96±12.08/32.65±10.73MT+Ex/ExUnclear4 weeks4 weeks①④(47)
Eliason et al, 2021Subacromial pain syndrome29/52 43.2±9.8/45.5±8.3MT+Ex/ExMT: 1-2 times a week; Ex: twice a week6 weeks6 months①⑦(18)
Haider et al, 2018Subacromial pain20/20 49.3±9.99/49.8±9.67MT+Ex/Ex3 sessions per week2 weeks2 weeks②⑤(19)
Kachingwe et al, 2008Shoulder impingement9/8 48.9±13.7/47.3±20.1MT+Ex/ExMT: once per week; Ex: once per day6 weeks6 weeks①⑤(48)
Kromer et al, 2014Shoulder impingement syndrome46/44 50.1±12.2/53.7±9.9MT+Ex/ExMT: 10 sessions in 5 weeks; Ex: 10 sessions in 5 weeks5 weeks12 weeks①⑤(49)
Park et al, 2020Subacromial impingement syndrome10/10 49.2±9.48/50.9±9.1MT+Ex/Ex3 sessions per week\4 weeks4 weeks(23)
Sharma et al, 2021Shoulder impingement syndrome40/40 21.3±2.1/21.8±2.8MT+Ex/ExMT:12 sessions over 8 weeks; Ex: twice per day8 weeks8 weeks(24)
Senbursa et al, 2007Shoulder impingement syndrome15/15 48.1±7.5/49.5±7.9MT+Ex/ExMT: 3 times per week; Ex: 7 times per week4 weeks4 weeks(50)
Vinuesa-Montoya et al, 2017Shoulder impingement21/19 46.85±8.02/51.21±5.29MT+Ex/ExMT: twice per week; Ex: twice a day5 weeks5 weeks①④(51)
Manual therapy plus multimodal physiotherapy vs. multimodal physiotherapy
Author, yearDiagnosisSample size (Exp/Ctr)Age (Exp/Ctr)Intervention (Exp/Ctr)FrequencyTreatment durationFollow-up periodOutcome(Refs.)
Barra López et al, 2013Subacromial impingement syndrome40/40 56.2±12/59.1±11.5MT + MP/MPMT: 2 sessions per week;MP: 5 sessions per week3 weeks3 months①⑦(52)
İğrek and Çolak, 2021Subacromial impingement syndrome15/14 44.4±11/45.9±9.7MT + MP/MP5 times per week4 weeks16 weeks①④(21)
Menek et al, 2019Roator cuff syndrome15/15 51.73±6.64/50.26±4.28MT + MP/MP5 times per week6 weeks6 weeks①④(22)

[i] (1) Exp, experiment group; Ctr, control group; MT, manual therapy; Ex, exercise; MP, multimodal physiotherapy. (2) Outcomes; ①VAS, Visual Analogue Scale; ② NPRS, Numeric Pain Rating Scale; ③ CMS, pain component of the Constant–Murley Score; ④ DASH, Disability of the Arm, Shoulder, and Hand; ⑤ SPADI, Shoulder Pain and Disability Index; ⑥ Penn, Pennsylvania Shoulder Score; ⑦ CMS, Follow-up period: the time from baseline to last follow-up visit.

Risk of bias assessment

The average PEDro scale score across the 24 RCTs was 6.45 (Table III). A total of 19 trials scored ≥6 on the PEDro scale, indicating a low risk of bias. Among the five studies scoring <6, the limitations primarily involved inadequate concealment of allocation, insufficient blinding of participants and therapists, and failure to adhere to intention-to-treat principles.

Table III

Risk of bias assessment using the physiotherapy evidence database scale.

Table III

Risk of bias assessment using the physiotherapy evidence database scale.

  PEDro scale
Trial1234567891011Total
Atkinson et al (38), 2008----6
Aytar et al (39), 2015---7
Silva et al (25), 2019---7
Delgado-Gil et al (40), 2015--8
Guimarães et al (41), 2016---7
Haik et al (42), 2017--8
Hunter et al (20), 2022---7
Kardouni et al (43), 2015---7
McClatchie et al (44), 2009----6
Surenkok et al (45), 2009-----5
Akbaba et al (17), 2019--8
Bang and Deyle (46), 2000----6
Camargo et al (47), 2015--8
Eliason et al (18), 2021--8
Haider et al (19), 2018-----5
Kachingwe et al (48), 2008-----5
Kromer et al (49), 2014---7
Park et al (23), 2020----6
Sharma et al (24), 2021---7
Senbursa et al (50), 2007------4
Vinuesa-Montoya et al (51), 2017---7
Barra López et al (52), 2013----6
İğrek and Çolak (21), 2021---7
Menek et al (22), 2019-----5

[i] The search terms of #1-6, #8-14, #16-22 were connected with ‘OR’ respectively, and then the three combinations were connected with ‘AND’ to search the target study.

MT vs. Placebo

Pain. A total of 10 studies evaluated changes in shoulder pain after MT compared with placebo. The heterogeneity analysis indicated acceptable heterogeneity (I2=44% and P=0.07). Meta-analysis demonstrated that MT could not effectively relieve pain (SMD=-0.25; 95% CI: -0.51 to 0.01; Z=1.89; P=0.06). Subgroup analysis revealed that while a single session of MT showed no significant difference in pain reduction compared with placebo, multiple MT sessions were associated with superior pain relief (SMD=-0.43; 95% CI: -0.68 to -0.18; Z=3.38; P=0.0007) (Fig. 2). Only one study (20) conducted a 12-month long-term follow-up, indicating sustained pain relief with MT compared with placebo (P=0.01). In addition, subgroup analysis based on the MT regimen were also attempted, but there was high heterogeneity in subgroup (I2=81% and P=0.02) and no reliable conclusions could be drawn (data not shown).

Function

A total of six studies evaluated improvements in functional scores with MT compared with placebo. Heterogeneity analysis revealed that I2=27% and P=0.23. Comprehensive analysis showed no significant difference in functional improvement between MT and placebo (SMD=0.20; 95% CI: -0.09 to 0.49; Z=1.33; P=0.18). In subgroup analysis, there was no significant difference in functional improvement after MT alone vs. placebo, with either a single intervention or more than one session (Fig. 3).

MT plus exercise vs. exercise alone

Pain. The additional efficacy of MT in pain reduction when added to exercise therapy was examined in nine studies. There was high heterogeneity in the analysis (I2=50%; P=0.04). Pooled results showed that the addition of MT resulted in additional pain reduction compared with exercise therapy alone (SMD=0.36; 95% CI: 0.08 to 0.64; Z=2.50; P=0.01). A sensitivity analysis was performed because of the high heterogeneity (I2=36%; P=0.15). Removal of the study by Haider et al (19) provided a significant reduction in heterogeneity but did not change the overall findings (SMD=0.27; 95% CI: 0.01 to 0.53; Z=2.05; P=0.04) (Fig. 4).

Function

A total of nine RCTs evaluated the additional improvement in function with MT added to exercise therapy. The heterogeneity was acceptable (I2=11%; P=0.34). Combined results indicated that MT plus exercise therapy led to greater functional improvement compared with exercise alone (SMD=0.32; 95% CI: 0.11 to 0.52; Z=3.07; P=0.002) (Fig. 5).

MT plus multimodal physiotherapy vs. multimodal physiotherapy

Pain. A total of three studies compared the effect of MT plus multimodal physiotherapy vs. multimodal physiotherapy alone on pain reduction. There was a high level of heterogeneity (I2=89%; P=0.0001). Meta-analysis indicated that MT combined with multimodal physiotherapy achieved superior pain relief compared with multimodal physiotherapy alone (MD=1.57; 95% CI: 0.18 to 2.96; Z=2.22; P=0.03). A sensitivity analysis was performed because of the high heterogeneity. Removal of the study by Menek et al (22) provided a significant reduction in heterogeneity (I2=0%; P=0.78) but did not change the overall findings (MD=0.86; 95% CI: 0.40 to 1.33; Z=3.65; P=0.0003) (Fig. 6).

Function

A total of three studies compared the effect of MT plus multimodal physiotherapy with multimodal physiotherapy alone on functional improvement. The heterogeneity was acceptable (I2=0%; P=0.82). Meta-analysis revealed that MT combined with multimodal physiotherapy achieved superior functional improvement compared with multimodal physiotherapy alone (SMD=0.77; 95% CI: 0.43 to 1.12; Z=4.38; P<0.0001) (Fig. 7).

Discussion

The present systematic review and meta-analysis assessed the efficacy of MT for RCI in terms of pain and function. The results of the present study indicated that the improvement of shoulder pain and function in RCI patients with MT alone is limited. However, when combined with exercise or multimodal physiotherapy, MT not only significantly reduced pain but also enhanced shoulder function.

The present study revealed that MT alone is not effective in reducing pain compared with placebo, which is inconsistent with the findings of previous meta-analyses (14,15). However, these previous studies had limitations in the number of included RCTs and lacked pooled outcomes regarding functional improvements. No significant difference in functional improvement between MT alone and placebo were discovered. Additionally, a variation in the number of interventions across trials was observed, highlighting that the optimal number of MT sessions for RCI remains unknown (53-55). Subgroup analysis revealed that multiple intervention sessions led to improved pain relief than single sessions, suggesting the need to use multiple MT sessions in clinical practice.

In the clinical setting, MT and exercises are commonly preferred as primary physiotherapy treatments for shoulder syndromes (56). Consistent with previous studies, the findings of the present study revealed that combining MT with exercise yielded superior outcomes compared with exercise alone. This may be attributed to the analgesic effect and correction of muscle-bone imbalance by early MT, providing optimal conditions for exercise implementation (23,24). Exercises should be tailored to the patient's condition and combined with appropriate restraint to regulate and repair muscle metabolism (57).

The present study is the first systematic review to examine the efficacy of MT added to multimodal physiotherapy for the treatment of RCI, and it was revealed that the addition of MT improved the effectiveness of treatment. Although multimodal physiotherapy was not strictly defined, the included trials commonly used exercise and electrotherapy interventions. Electrotherapy, including infrared, therapeutic ultrasound, and transcutaneous electrical nerve stimulation (58), is a common treatment modality for rotator cuff disease that achieves pain relief and muscle relaxation. The results indicated a synergistic effect of MT with multimodal physiotherapy, especially exercise and electrotherapy.

Several pooled results exhibited high heterogeneity when MT was combined with exercise or multimodal physiotherapy. In comparing the efficacy of pain reduction between the combination of MT and exercise vs. exercise alone, a significant reduction in heterogeneity was obtained after the study by Haider et al (19) was excluded from the sensitivity analysis. The study characteristics by Haider et al were reviewed and compared with other studies and the duration of intervention was revealed to be shorter in the present study (2 weeks) than in other studies (at least 3 weeks). When comparing pain improvement between MT combined with multimodal physiotherapy and multimodal physiotherapy alone, the study by Menek et al (22) used a longer duration of intervention (6 weeks) than the other studies (<4 weeks). These results suggested that duration of intervention may be a potential source of heterogeneity.

The present study has certain limitations. Of the 24 included studies, only one (20) had a long-term follow-up of 1 year and showed that MT improved pain more efficiently than placebo, but the study did not report whether there was disease progression. As a meta-analysis could not be performed, the long-term efficacy of MT for RCI and whether it will lead to disease progression are uncertain. Moreover, therapeutic time window, comorbidities and degree of injury are the confounding factors. Because of the lack of description of these conditions in the included studies, subgroup analysis could not be performed. Due to the limited number of studies on MT for RCI, further network meta-analysis could not be performed.

In conclusion, the results of the present meta-analysis demonstrated that combining MT with exercise therapy or multimodal physiotherapy not only enhances pain relief compared with exercise therapy or multimodal physiotherapy alone, but also effectively improves shoulder joint function. Therefore, MT is considered a pivotal component of conservative treatments, and its integration with other therapeutic approaches is recommended for optimal RCI therapy.

Supplementary Material

Search strategy of PubMed.

Acknowledgements

Not applicable.

Funding

Funding: The present study was supported by the Medical Innovation Project of Shanghai Science and Technology Commission (grant nos. 21Y11921300 and 22Y11922500), the Shanghai Health and Family Planning System Excellent Young Medical Personnel Training Program (grant no. 2018YQ27), the Future Plan of Shanghai Municipal Hospital of Traditional Chinese Medicine (grant nos. ZLZX001, GZS001, MZY034 and XJRY2021003K), the Training Program for High-caliber Talents of Clinical Research at Affiliated Hospitals of SHUTCM (grant no. 2023LCRC18), the Shanghai University of Traditional Chinese Medicine ‘Xinglin Hundred Talents’ Plan [grant no. TCM (2020) 23] and the Shanghai University of Traditional Chinese Medicine Reserve Outstanding TCM Talents [grant no. TCM(2020) 10].

Availability of data and materials

The data generated in the present study may be requested from the corresponding author.

Authors' contributions

SL and XL conceptualized and designed the present study. QS and XL provided administrative support. SL, LC, YF, WD and CX carried out data collection. LS and LXF confirm the authenticity of all the raw data. All authors participated in data analysis and interpretation, the writing process, and read and approved the final manuscript. All the authors confirm that the study followed PRISMA guidelines.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

1 

Lewis J, Mccreesh K, Roy JS and Ginn K: Rotator cuff tendinopathy: Navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther. 45:923–937. 2015.PubMed/NCBI View Article : Google Scholar

2 

Weber S and Chahal J: Management of rotator cuff injuries. J Am Acad Orthop Surg. 28:e193–e201. 2020.PubMed/NCBI View Article : Google Scholar

3 

Sambandam SN, Khanna V, Gul A and Mounasamy V: Rotator cuff tears: An evidence based approach. World J Orthop. 6:902–918. 2015.PubMed/NCBI View Article : Google Scholar

4 

Godeau D, Fadel M and Descatha A: Factors associated with limitations in daily life and at work in a population with shoulder pain. BMC Musculoskelet Disord. 23(777)2022.PubMed/NCBI View Article : Google Scholar

5 

Consigliere P, Haddo O, Levy O and Sforza G: Subacromial impingement syndrome: management challenges. Orthop Res Rev. 10:83–91. 2018.PubMed/NCBI View Article : Google Scholar

6 

Ulack C, Suarez J, Brown L, Ring D, Wallace S and Teisberg E: What are people that seek care for rotator cuff tendinopathy experiencing in their daily life? J Patient Exp. 9(23743735211069811)2022.PubMed/NCBI View Article : Google Scholar

7 

Osborne JD, Gowda AL, Wiater B and Wiater JM: Rotator cuff rehabilitation: Current theories and practice. Phys Sportsmed. 44:85–92. 2016.PubMed/NCBI View Article : Google Scholar

8 

Lewis J: Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 23:57–68. 2016.PubMed/NCBI View Article : Google Scholar

9 

Zhou D, Zhou F, Sheng S, Wei Y, Chen X and Su J: Intra-articular nanodrug delivery strategies for treating osteoarthritis. Drug Discov Today. 28(103482)2023.PubMed/NCBI View Article : Google Scholar

10 

Mi CH, Qi XY, Ding YW, Zhou J, Dao JW and Wei DX: Recent advances of medical polyhydroxyalkanoates in musculoskeletal system. Biomater Transl. 4:234–247. 2023.PubMed/NCBI View Article : Google Scholar

11 

Sun S, Liu H, Hu Y, Wang Y, Zhao M, Yuan Y, Han Y, Jing Y, Cui J, Ren X, et al: Selection and identification of a novel ssDNA aptamer targeting human skeletal muscle. Bioact Mater. 20:166–178. 2022.PubMed/NCBI View Article : Google Scholar

12 

Ying J, Yu H, Cheng L, Li J, Wu B, Song L, Yi P, Wang H, Liu L and Zhao D: Research progress and clinical translation of three-dimensional printed porous tantalum in orthopaedics. Biomater Transl. 4:166–179. 2023.PubMed/NCBI View Article : Google Scholar

13 

Li J, Zhang H, Han Y, Hu Y, Geng Z and Su J: Targeted and responsive biomaterials in osteoarthritis. Theranostics. 13:931–954. 2023.PubMed/NCBI View Article : Google Scholar

14 

Desjardins-Charbonneau A, Roy JS, Dionne CE, Frémont P, MacDermid JC and Desmeules F: The efficacy of manual therapy for rotator cuff tendinopathy: A systematic review and meta-analysis. J Orthop Sports Phys Ther. 45:330–350. 2015.PubMed/NCBI View Article : Google Scholar

15 

Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J and Hilfiker R: Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: A systematic review and meta-analysis of RCTs. Br J Sports Med. 51:1340–1347. 2017.PubMed/NCBI View Article : Google Scholar

16 

Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, Mrocki MA and Buchbinder R: Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016(CD012224)2016.PubMed/NCBI View Article : Google Scholar

17 

Akbaba YA, Mutlu EK, Altun S, Turkmen E, Birinci T and Celik D: The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study. J Back Musculoskelet Rehabil. 32:519–527. 2019.PubMed/NCBI View Article : Google Scholar

18 

Eliason A, Harringe M, Engström B and Werner S: Guided exercises with or without joint mobilization or no treatment in patients with subacromial pain syndrome: A clinical trial. J Rehabil Med. 53(jrm00190)2021.PubMed/NCBI View Article : Google Scholar

19 

Haider R, Bashir MS, Adeel M, Ijaz MJ and Ayub A: Comparison of conservative exercise therapy with and without maitland thoracic manipulative therapy in patients with subacromial pain: Clinical trial. J Pak Med Assoc. 68:381–387. 2018.PubMed/NCBI

20 

Hunter DJ, Rivett DA, Mckiernan S, Luton R and Snodgrass SJ: Thoracic manual therapy improves pain and disability in individuals with shoulder impingement syndrome compared with placebo: A randomized controlled trial with 1-year follow-up. Arch Phys Med Rehabil. 103:1533–1543. 2022.PubMed/NCBI View Article : Google Scholar

21 

İğrek A and Çolak TK: Comparison of the effectiveness of proprioceptive neuromuscular facilitation exercises and shoulder mobilization patients with subacromial impingement syndrome: A randomized clinical trial. J Bodyw Mov Ther. 30:42–52. 2022.PubMed/NCBI View Article : Google Scholar

22 

Menek B, Tarakci D and Algun ZC: The effect of Mulligan mobilization on pain and life quality of patients with rotator cuff syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil. 32:171–178. 2019.PubMed/NCBI View Article : Google Scholar

23 

Park SJ and Kim SH and Kim SH: Effects of thoracic mobilization and extension exercise on thoracic alignment and shoulder function in patients with subacromial impingement syndrome: A randomized controlled pilot study. Healthcare (Basel). 8:316–326. 2020.PubMed/NCBI View Article : Google Scholar

24 

Sharma S, Ejaz Hussain M and Sharma S: Effects of exercise therapy plus manual therapy on muscle activity, latency timing and SPADI score in shoulder impingement syndrome. Complement Ther Clin Pract. 44(101390)2021.PubMed/NCBI View Article : Google Scholar

25 

Silva ACD, Santos GM, Marques CMDG and Marques JLB: Immediate effects of spinal manipulation on shoulder motion range and pain in individuals with shoulder pain: A randomized trial. J Chiropr Med. 18:19–26. 2019.PubMed/NCBI View Article : Google Scholar

26 

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, et al: The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann Intern Med. 162:777–784. 2015.PubMed/NCBI View Article : Google Scholar

27 

Verhagen AP, De Vet HC, De Bie RA, Kessels AG, Boers M, Bouter LM and Knipschild PG: The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 51:1235–1241. 1998.PubMed/NCBI View Article : Google Scholar

28 

Macedo LG, Elkins MR, Maher CG, Moseley AM, Herbert RD and Sherrington C: There was evidence of convergent and construct validity of physiotherapy evidence database quality scale for physiotherapy trials. J Clin Epidemiol. 63:920–925. 2010.PubMed/NCBI View Article : Google Scholar

29 

Maher CG, Sherrington C, Herbert RD, Moseley AM and Elkins M: Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 83:713–721. 2003.PubMed/NCBI

30 

Sherrington C, Herbert RD, Maher CG and Moseley AM: PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man Ther. 5:223–226. 2000.PubMed/NCBI View Article : Google Scholar

31 

Karanasios S, Tsamasiotis GK, Michopoulos K, Sakellari V and Gioftsos G: Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: Systematic review and meta-analysis. Clin Rehabil. 35:1383–1398. 2021.PubMed/NCBI View Article : Google Scholar

32 

Jiménez-Del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E and Pérez-Bellmunt A: The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: A systematic review and meta-analysis. Int Orthop. 46:301–312. 2022.PubMed/NCBI View Article : Google Scholar

33 

Siddall B, Ram A, Jones MD, Booth J, Perriman D and Summers SJ: Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: A systematic review and meta-analysis. Pain. 163:e20–e30. 2022.PubMed/NCBI View Article : Google Scholar

34 

Hahne AJ, Ford JJ and McMeeken JM: Conservative management of lumbar disc herniation with associated radiculopathy: A systematic review. Spine (Phila Pa 1976). 35:E488–E504. 2010.PubMed/NCBI View Article : Google Scholar

35 

Slater SL, Ford JJ, Richards MC, Taylor NF, Surkitt LD and Hahne AJ: The effectiveness of sub-group specific manual therapy for low back pain: A systematic review. Man Ther. 17:201–212. 2012.PubMed/NCBI View Article : Google Scholar

36 

Higgins JPT, Thompson SG, Deeks JJ and Altman DG: Measuring inconsistency in meta-analyses. BMJ. 327:557–560. 2003.PubMed/NCBI View Article : Google Scholar

37 

DerSimonian R and Laird N: Meta-analysis in clinical trials. Control Clin Trials. 7:177–188. 1986.PubMed/NCBI View Article : Google Scholar

38 

Atkinson M, Matthews R, Brantingham JW, Globe G, Cassa T, Bonnefin D and Korporaal C: A randomized controlled trial to assess the efficacy of shoulder manipulation versus placebo in the treatment of shoulder pain due to rotator cuff tendinopathy. J Am Chiropr Assoc. 45:11–26. 2008.

39 

Aytar A, Baltaci G, Uhl TL, Tuzun H, Oztop P and Karatas M: The effects of scapular mobilization in patients with subacromial impingement syndrome: A randomized, double-blind, placebo-controlled clinical trial. J Sport Rehabil. 24:116–129. 2015.PubMed/NCBI View Article : Google Scholar

40 

Delgado-Gil JA, Prado-Robles E, Rodrigues-de-Souza DP, Cleland JA, Fernández-de-las-Peñas C and Alburquerque-Sendín F: Effects of mobilization with movement on pain and range of motion in patients with unilateral shoulder impingement syndrome: A randomized controlled trial. J Manipulative Physiol Ther. 38:245–252. 2015.PubMed/NCBI View Article : Google Scholar

41 

Guimarães JF, Salvini TF, Siqueira AL Jr, Ribeiro IL, Camargo PR and Alburquerque-Sendín F: Immediate effects of mobilization with movement vs sham technique on range of motion, strength, and function in patients with shoulder impingement syndrome: Randomized clinical trial. J Manipulative Physiol Ther. 39:605–615. 2016.PubMed/NCBI View Article : Google Scholar

42 

Haik MN, Alburquerque-Sendin F and Camargo PR: Short-term effects of thoracic spine manipulation on shoulder impingement syndrome: A randomized controlled trial. Arch Phys Med Rehabil. 98:1594–1605. 2017.PubMed/NCBI View Article : Google Scholar

43 

Kardouni JR, Pidcoe PE, Shaffer SW, Finucane SD, Cheatham SA, Sousa CO and Michener LA: Thoracic spine manipulation in individuals with subacromial impingement syndrome does not immediately alter thoracic spine kinematics, thoracic excursion, or scapular kinematics: A randomized controlled trial. J Orthop Sports Phys Ther. 45:527–538. 2015.PubMed/NCBI View Article : Google Scholar

44 

McClatchie L, Laprade J, Martin S, Jaglal SB, Richardson D and Agur A: Mobilizations of the asymptomatic cervical spine can reduce signs of shoulder dysfunction in adults. Man Ther. 14:369–374. 2009.PubMed/NCBI View Article : Google Scholar

45 

Surenkok O, Aytar A and Baltaci G: Acute effects of scapular mobilization in shoulder dysfunction: A double-blind randomized placebo-controlled trial. J Sport Rehabil. 18:493–501. 2009.PubMed/NCBI View Article : Google Scholar

46 

Bang MD and Deyle GD: Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 30:126–137. 2000.PubMed/NCBI View Article : Google Scholar

47 

Camargo PR, Alburouerque-Sendin F, Avila MA, Haik MN, Vieira A and Salvini TF: Effects of stretching and strengthening exercises, with and without manual therapy, on scapular kinematics, function, and pain in individuals with shoulder impingement: A randomized controlled trial. J Orthop Sports Phys Ther. 45:984–997. 2015.PubMed/NCBI View Article : Google Scholar

48 

Kachingwe AF, Phillips B, Sletten E and Plunkett SW: Comparison of manual therapy techniques with therapeutic exercise in the treatment of shoulder impingement: A randomized controlled pilot clinical trial. J Man Manip Ther. 16:238–247. 2008.PubMed/NCBI View Article : Google Scholar

49 

Kromer TO, de Bie RA and Bastiaenen CH: Effectiveness of physiotherapy and costs in patients with clinical signs of shoulder impingement syndrome: One-year follow-up of a randomized controlled trial. J Rehabil Med. 46:1029–1036. 2014.PubMed/NCBI View Article : Google Scholar

50 

Senbursa G, Baltaci G and Atay A: Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: A prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 15:915–921. 2007.PubMed/NCBI View Article : Google Scholar

51 

Vinuesa-Montoya S, Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Fernández-Sánchez M, Fernández-Espinar EM and Castro-Sánchez AM: A preliminary randomized clinical trial on the effect of cervicothoracic manipulation plus supervised exercises vs a home exercise program for the treatment of shoulder impingement. J Chiropr Med. 16:85–93. 2017.PubMed/NCBI View Article : Google Scholar

52 

Barra López ME, López de Celis C, Fernández Jentsch G, Raya de Cárdenas L, Lucha López MO and Tricás Moreno JM: Effectiveness of diacutaneous fibrolysis for the treatment of subacromial impingement syndrome: A randomised controlled trial. Man Ther. 18:418–424. 2013.PubMed/NCBI View Article : Google Scholar

53 

Haas M, Bronfort G, Evans R, Schulz C, Vavrek D, Takaki L, Hanson L, Leininger B and Neradilek MB: Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: A dual-center randomized controlled trial. Spine J. 18:1741–1754. 2018.PubMed/NCBI View Article : Google Scholar

54 

Sturman S and Killingback C: Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia? J Bodyw Mov Ther. 24:141–153. 2020.PubMed/NCBI View Article : Google Scholar

55 

Perlman AI, Ali A, Njike VY, Hom D, Davidi A, Gould-Fogerite S, Milak C and Katz DL: Massage therapy for osteoarthritis of the knee: A randomized dose-finding trial. PLoS One. 7(e30248)2012.PubMed/NCBI View Article : Google Scholar

56 

Kooijman M, Swinkels I, Van Dijk C, de Bakker D and Veenhof C: Patients with shoulder syndromes in general and physiotherapy practice: An observational study. BMC Musculoskelet Disord. 14(128)2013.PubMed/NCBI View Article : Google Scholar

57 

Eggelbusch M, Charlton BT, Bosutti A, Ganse B, Giakoumaki I, Grootemaat AE, Hendrickse PW, Jaspers Y, Kemp S, Kerkhoff TJ, et al: The impact of bed rest on human skeletal muscle metabolism. Cell Rep Med. 5(101372)2024.PubMed/NCBI View Article : Google Scholar

58 

Page MJ, Green S, Mrocki MA, Surace SJ, Deitch J, McBain B, Lyttle N and Buchbinder R: Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev. 2016(CD012225)2016.PubMed/NCBI View Article : Google Scholar

Related Articles

Journal Cover

June-2024
Volume 20 Issue 6

Print ISSN: 2049-9434
Online ISSN:2049-9442

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
x
Spandidos Publications style
Liu S, Chen L, Shi Q, Fang Y, Da W, Xue C and Li X: Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis. Biomed Rep 20: 89, 2024.
APA
Liu, S., Chen, L., Shi, Q., Fang, Y., Da, W., Xue, C., & Li, X. (2024). Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis. Biomedical Reports, 20, 89. https://doi.org/10.3892/br.2024.1778
MLA
Liu, S., Chen, L., Shi, Q., Fang, Y., Da, W., Xue, C., Li, X."Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis". Biomedical Reports 20.6 (2024): 89.
Chicago
Liu, S., Chen, L., Shi, Q., Fang, Y., Da, W., Xue, C., Li, X."Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis". Biomedical Reports 20, no. 6 (2024): 89. https://doi.org/10.3892/br.2024.1778