title: Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis.
abstract: OBJECTIVE
  To determine the effectiveness of exercise and soft tissue massage either in isolation or in combination for the treatment of non-specific shoulder problems.
  
  
  METHODS
  Database searches for articles from 1966 to December 2011 were performed. Studies were eligible if they investigated 'hands on' soft tissue massage performed locally to the shoulder or exercises aimed at improving strength, range of motion or coordination; non-surgical painful shoulder disorders; included participants aged 18-80 years and outcomes measured included pain, disability, range of motion, quality of life, work status, global perceived effect, adverse events or recurrence.
  
  
  RESULTS
  Twenty-three papers met the selection criteria representing 20 individual trials. We found low-quality evidence that soft tissue massage was effective for producing moderate improvements in active flexion and abduction range of motion, pain and functional scores compared with no treatment, immediately after the cessation of treatment. Exercise was shown by meta-analysis to produce greater improvements than placebo, minimal or no treatment in reported pain (weighted mean=9.8 of 100, 95% CI 0.6 to 19.0) but these changes were of a magnitude that was less than that considered clinically worthwhile. Exercise did not produce greater improvements in shoulder function than placebo, minimal or no treatment (weighted mean=5.7 of 100, 95% CI -3.3 to 14.7).
  
  
  CONCLUSIONS
  There is low-quality evidence that soft tissue massage is effective for improving pain, function and range of motion in patients with shoulder pain in the short term. Exercise therapy is effective for producing small improvements in pain but not in function or range of motion.
authors: Discipline of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia Department of Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
authors: Paul Andrew
authors: PA
authors: van den Dolder
authors: Discipline of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia.
authors: Paulo H
authors: PH
authors: Ferreira
authors: Discipline of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia.
authors: Kathryn M
authors: KM
authors: Refshauge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020069:Shoulder Pain / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult