Content » Vol 53, Issue 5

Original report

Guided exercises with or without joint mobilization or no treatment in patients with subacromial pain syndrome: A clinical trial

Anna Eliason, Marita Harringe, Björn Engström, Suzanne Werner
Stockholm Sports Trauma Research center. Dep of Molecular Medicine and Surgery, Solna, Sweden. E-mail:
DOI: 10.2340/16501977-2806


Background: Graded resistance training is the recommended treatment for patients with subacromial pain syndrome. It is debated whether adding joint mobilization will improve the outcome. The aim of this study was to evaluate the clinical outcome of guided exercises with or without joint mobilization, compared with controls who did not receive any treatment.
Methods: A 3-armed controlled trial in a primary care setting. A total of 120 patients, with clinically diagnosed subacromial pain syndrome, were randomized into guided exercise groups with and without additional joint mobilization, and a control group that did not receive any treatment. Data were analysed at baseline, 6 weeks, 12 weeks and 6 months. Primary outcome was the Constant-Murley score, and secondary outcomes were pain and active range of motion.
Results: Shoulder function improved in all groups, as measured with the Constant-Murley score. At 12 weeks and 6 months the exercise groups improved significantly compared with the control group (p ≤ 0. 05). Add-on joint mobilization resulted in decreased pain in active range of motion at 6 and 12 weeks compared with guided exercise or no treatment (p ≤ 0. 05). Range of motion increased over time in all 3 groups.
Conclusion: In patients with subacromial pain syndrome guided exercises improved shoulder function compared with no treatment. Add-on joint mobilization decreased pain in the short-term compared with exercise alone or no treatment.

Lay Abstract

To determine treatment efficacy in patients with shoulder pain treated with a combination of joint mobilization and guided training or guided training alone, and compare this with a control group who received no treatment. The study was a randomized controlled trial in Swedish primary care. A total of 120 patients aged between 20 and 59 years were recruited from general practice in Stockholm. Guided exercises, with or without joint mobilization, improved shoulder function compared with no treatment. In the short term, add-on joint mobilization decreased pain, and may thus serve as a substitute for non-steroidal anti-inflammatory drugs (NSAIDs) or other painkillers at the start of a treatment period.


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