The Natural Shoulder Pain Solution Bibliography

Effectiveness Of Exercises In Reducing Pain, Improving Quality of Life and Reducing Need For Surgery:

Ellenbecker, Todd. Shoulder Rehabilitation : Non-Operative Treatment. New York, NY, USA: Thieme New York, 2006. ProQuest ebrary. Web. 19 February 2015.

Clin Orthop Relat Res. 2001 Jan;(382):99-107.

Outcome of nonoperative management of full-thickness rotator cuff tears.

Goldberg BA1, Nowinski RJ, Matsen FA 3rd.

Conclusion: Treatment consisted only of patient education and a home program of gentle stretching and strengthening. Patients completed the Simple Shoulder Test at the initial visit and sequentially at 6-month intervals thereafter. At an average followup of 2.5+/-1.6 years, 27 (59%) patients experienced improvement with nonoperative treatment, 14 (30%) patients experienced worsening, and five (11%) patients remained unchanged.

“SUBACROMIAL IMPINGEMENT: Shoulder Exercise ‘Prevents Surgery’.” Pulse (2012): 13. ProQuest. Web. 18 Feb. 2015.

shows that versus control group, only 20% of group given home exercises for rotator cuff and scapular stabilizer muscles chose to have surgery, 63% of control chose to have surgery.

Clinical Journal of Sport Medicine

Issue: Volume 23(1), January 2013, p 86–87

Litchfield, Robert MD

Progressive Strengthening Exercises for Subacromial Impingement Syndrome


When the surgeon discussed the option of surgery with the patients at the end of the trial, a lower proportion of patients in the specific exercise group chose surgery. The authors note that the treatment effect that they found is similar in magnitude to that found in surgical trials of subacromial decompression.

Ginn, K. A., & Cohen, M. L. (2005). EXERCISE THERAPY FOR SHOULDER PAIN AIMED AT RESTORING NEUROMUSCULAR CONTROL: A RANDOMIZED COMPARATIVE CLINICAL TRIAL. Journal Of Rehabilitation Medicine (Taylor & Francis Ltd), 37(2), 115-122.

Craig A. Cummins, Lisa M. Sasso, Daniel Nicholson, Impingement syndrome: Temporal outcomes of nonoperative treatment, Journal of Shoulder and Elbow Surgery, Volume 18, Issue 2, March–April 2009, Pages 172-177, ISSN 1058-2746,


“although impingement syndrome represents the supraspinatus tendon impinging under the acromion, it does not necessarily define the extent of the underlying pathologic shoulder disorder. It is only after obtaining more data from a thorough physical examination, imaging tests, or arthroscopy that a more specific pathologic diagnosis becomes clear.

Regardless of the underlying pathology, most patients who present with impingement syndrome respond favorably to nonoperative treatment, with previous studies having demonstrated success rates of approximately 70%

A randomized, controlled clinical trial of a treatment for shoulder pain

Ginn, Karen AView Profile; Herbert, Robert D; Khouw, Wendy; Lee, Rebecca. Physical Therapy77.8(Aug 1997): 802-9; discussion 810-1.


This randomized controlled trial demonstrated that a program of physical therapy aimed at restoring muscle force, length, and control at the painful shoulder produces better outcomes than does no treatment.

These results highlight the importance of muscle stretching, strengthening, and reeducation in the treatment of shoulder pain of local mechanical origin and suggest that spontaneous recovery of shoulder pain cannot be expected.

J Physiother. 2012;58(2):127. doi: 10.1016/S1836-9553(12)70093-0.

A specific exercise program for patients with subacromial impingement syndrome can improve function and reduce the need for surgery.

– a specific, progressive exercise program focusing on training the rotator cuff and scapular stabilisers were effective in improving function, reducing pain, and reducing the need of surgery for patients with chronic subacromial impingement syndrome

Clin J Sport Med. 2013 Jan;23(1):86-7. doi: 10.1097/JSM.0b013e31827e9fb5.

Progressive strengthening exercises for subacromial impingement syndrome.

Conclusions: A 3-month specifically tailored progressive strengthening exercise program was more beneficial in improving shoulder function in subacromial impingement syndrome than were non specific exercises. More patients felt their treatment was successful, and fewer subsequently chose surgery.

Clin Rehabil. 2011 Jan;25(1):69-78. doi: 10.1177/0269215510376005. Epub 2010 Aug 16.

Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome.

Bernhardsson S1, Klintberg IH, Wendt GK.

Conclusions: A 12-week eccentric strengthening programme targeting the rotator cuff and incorporating scapular control and correct movement pattern can be effective in decreasing pain and increasing function in patients with subacromial impingement syndrome. A randomized controlled trial is necessary to provide stronger evidence of the method.

Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up

J P Haahr1, S Østergaard2, J Dalsgaard3, K Norup4, P Frost1, S Lausen2, E A Holm2, J H Andersen1

  Randomised controlled trial with 12 months’ follow up in a hospital setting

Conclusion: Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training. Further studies are needed to qualify treatment choice decisions, and it is recommended that samples are stratified according to disability level.

Effectiveness of Home Exercises:

J Shoulder Elbow Surg. 2013 Sep;22(9):1173-9. doi: 10.1016/j.jse.2013.01.008. Epub 2013 Mar 22.

A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears.

Krischak G1, Gebhard F, Reichel H, Friemert B, Schneider F, Fisser C, Kaluscha R, Kraus M.

Conclusions: Home-based exercise, on the basis of an illustrated booklet with exercises twice a day, supplies comparable results to formal occupational therapy in the conservative treatment of rotator cuff tears. The results of this pilot study suggest some potential advantages related to psychological benefits using home-based treatment.

J Rehabil Med. 2014 Nov;46(10):1029-36. doi: 10.2340/16501977-1867.

Effectiveness of physiotherapy and costs in patients with clinical signs of shoulder impingement syndrome: One-year follow-up of a randomized controlled trial.

Kromer TO1, de Bie RA, Bastiaenen CH.

Individualized exercises resulted in lower costs than manual physiotherapy and showed a significant effect on pain and functioning within the whole group after one year. Exercises should therefore be considered as a basic treatment. Due to the progressive improvement that occurred during the follow-up period with individualized exercises further treatments should be delayed for 3 to 4 months.

The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: Results of a prospective, randomized study

Markus Walther, MD, PhDa, , , Andreas Werner, MD, PhDb, Theresa Stahlschmidt, MDc, Rainer Woelfel, MD, PhDd, Frank Gohlke, MD, Prof.a

notes: 3 groups were given 3 different treatments – self-guided physical therapy exercises, traditional physiotherapy, and a brace. All 3 groups showed about the same level of improvement.


All three methods led to a significant improvement in the Constant-Murley score and a significant decrease in pain levels over a period of 12 weeks. The differences among the three groups were small and not statistically significant. This confirms the effect of muscular strengthening of the rotator cuff, either by physiotherapy or by guided self-training.

Frozen Shoulder:

Nonoperative management of idiopathic adhesive capsulitis

William N. Levine, MD, , Christine P. Kashyap, MD, Sean F. Bak, MD, Christopher S. Ahmad, MD, Theodore A. Blaine, MD, Louis U. Bigliani, MD

Conclusion: Most patients with idiopathic adhesive capsulitis can be successfully treated with a nonoperative treatment program consisting of a standardized physical therapy program alone or physical therapy with intraarticular corticosteroid injections.

Patients are more likely to fail nonoperative treatment if they initially present with worse declines in range of motion, fail to progress within 4 months of nonoperative treatment, or experience declines in range of motion from initial presentation. In addition, diabetic patients with adhesive capsulitis can also be successfully treated nonoperatively.

Yoga Therapy:

Rohnfeld, Edeltraud. Chair Yoga : Seated Exercises for Health and Wellbeing. London, GBR: Singing Dragon, 2011. ProQuest ebrary. Web. 20 February 2015.

Self-Education and Self-Treatment Resources:

Treat Your Own Rotator Cuff – By Jim Johnson

Bulletproof Your Shoulder – By Jim Johnson

Shoulder Pain? The Solution & Prevention, Revised & Expanded – by John M. Kirsch M.D.