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van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2012 Jul 26. [Epub ahead of print]

Shoulder pain is prevalent in the general population and the most injured site for swimmers. Many of these injuries are not classified with diagnostic imaging.

Non-specific shoulder pain is typically treated by a physical therapist. Many therapists commonly utilize massage and exercises during the intervention. The purpose of this study was to review the effectiveness of soft tissue massage and of exercise for non-specific shoulder pain when these interventions were compared with placebo, no treatment, another active treatment or when soft tissue massage or exercise were added to supplement to other interventions. 

What was done
The researchers used inclusion criteria: randomized controlled trials, adults, handling nearly all shoulder pathologies (tendonitis, impingement, frozen shoulder). A total of 23 studies were reviewed.

The review suggest there is low-quality evidence that soft tissue massage is effective in improving range of motion, function, and pain in patients with non-specific shoulder pain immediately following treatment. Exercise approaches improve non-specific shoulder pain immediately following treatment, but not in the short term.

The most effective location of soft tissue massage was to the lateral border of the shoulder blade. This resulted in a mean 22 degree improvement in flexion and 42 degree improvement in abduction, a decrease in the visual analog scale by 26.5 mm, and functional scores improved by 28.7%. Exercise appears to improve pain by 9.8 mm. Stretches to shortened muscles around the glenohumeral joint and high-intensity exercises show weak correlation with improvement. It is uncertain whether exercises benefit from professional supervision.

Soft tissue massage seems beneficial for improving pain, function, and range of motion in patients with non-specific shoulder pain in the short term. Strengthening exercises appear to produce small changes in pain, but not in function or range of motion.

Practical Implication
This is the first review on the effectiveness of soft tissue massage on shoulder pain. The positive results with massage need further research on larger groups and better grouped patients with their stage of injury (acute, sub-acute, chronic). This generalization does a disservice to the specifics of rehabilitative care.

Despite this, it seems soft tissue mobilization is effective in treating non-specific shoulder pain and one could speculate this techniques should be used as a preventative measure prior to injury.

Related Reading
Tennis Ball Tip (The “magic” of tissue work)

Fixing the “Disco” Crossover Swimmer with Scapular Stabilizer Tissue Work + Strengthening Exercises

Swimming Science Research Review 

This is a piece of the July Swimming Science Research Review. Read Swimming Science Research Review September 2012 for a complete list of the articles reviewed.

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Dr. John Mullen, DPT, CSCS world-renowned physical therapist and strength coach.
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