Effects of seven types of exercise in the treatment of rotator cuff-related shoulder pain (RCRSP): a systematic review and Bayesian network meta-analysis.

Rotator cuff-related shoulder pain is common, and exercise therapy is a standard treatment, but which type of exercise works best has remained unclear. This review pooled randomized trials comparing seven different exercise approaches, including concentric strengthening, eccentric strengthening, traditional training, motor control exercise, and scapula-focused training, using a statistical method that lets many treatments be compared indirectly through a shared network of studies. Across the pooled data, concentric strengthening training showed the strongest signal for improving shoulder dysfunction and also ranked highest for pain relief, though differences between most other exercise types for pain were largely non-significant. One approach, described only as HLT in the abstract, performed worst in most comparisons.

The evidence rests on a relatively modest number of trials (15 to 16 studies, under 1,000 participants each network), so these rankings should be read as suggestive rather than definitive, particularly for pain outcomes where comparisons were mostly not statistically significant.

If you have shoulder pain linked to the rotator cuff, a group of muscles and tendons that stabilize the shoulder joint, exercise is a commonly recommended treatment, but it hasn't been clear which type of exercise helps most. Researchers combined results from a number of clinical trials that tested different exercise styles, such as strengthening exercises done while muscles shorten (concentric) versus lengthen (eccentric), more traditional shoulder exercises, exercises focused on controlling movement patterns, and exercises targeting the shoulder blade muscles. Across this pooled evidence, concentric strengthening training stood out as the approach most consistently linked to better shoulder function, and it also tended to rank best for pain, though the pain comparisons between most exercise types weren't statistically significant.

One exercise type performed worse than the others in most comparisons. These findings come from a moderate number of trials, so they point toward concentric strengthening as a promising option rather than proving it is clearly superior, and they don't tell us what happens for every individual shoulder condition.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This network meta-analysis addresses a practical question in RCRSP management: among the range of exercise approaches used clinically, is there evidence favoring one over another for pain and dysfunction? Using Bayesian network meta-analysis across 15 studies (n=913) for pain and 16 studies (n=947) for dysfunction, the authors ranked seven exercise types via SUCRA scores. Concentric strengthening training (CST) showed a significant advantage over several comparators for shoulder dysfunction and the highest probability of ranking first for pain, with eccentric strengthening training (ECT) and traditional training moderately effective and significantly better than motor control exercise and scapula-focused training in some comparisons; HLT showed negative effect sizes in most comparisons. For pain specifically, comparisons between interventions other than CST were largely non-significant, so the ranking advantage for pain is less certain than for dysfunction.

The authors suggest ECT and motor control exercise as alternatives when CST is unsuitable, but this reflects ranking probabilities from indirect comparisons rather than a head-to-head trial finding. The abstract does not report heterogeneity statistics, risk-of-bias ratings, or adverse events, and the relatively modest number of trials per network limits confidence in subgroup-level rankings, meaning these results should inform rather than dictate exercise selection reasoning.