Several different techniques are now used to treat shoulder pain. Shoulder pain results from many MSK conditions e.g. Shoulder Osteoarthritis Rotator cuff tendinopathy. Surgery gives better results than non-surgical treatment in some cases, according to a study conditions ; while others have argued that nonsurgical interventions produce results equivalent to surgery . Several systematic reviews of the effectiveness of conservative interventions for shoulder pain have been published although evidence is currently insufficient to allows definitive conclusions about treatment of abuse . The primary goal of conservative management of shoulder pain is to reduce pain and improve function by correcting modifiable physical deformity .
Education plays a large role in managing individuals with shoulder pain. The physical therapist should provide a careful explanation to reassure the patient that no serious illness or injury has been diagnosed. Great care is needed to choose appropriate non-threatening words that will not do so misinterpreted by the patient and providing biomechanical information about the shoulder that is not based on evidence can compound their discomfort. It is important to avoid reinforcing individual fears about dangerous processes that may be occurring because these fears or concerns can act as a a barrier to recovery and must be effectively addressed. The key to treating individuals with shoulder pain is to encourage active movement. The ultimate goal is to help patients resume their usual activities as soon as possible. Counseling can be effective supported by the provision of simple evidence-based educational materials.
Exercise has a beneficial role to play and the inclusion of loaded exercise is safe and does not compromise outcome . In rotator cuff tendinopathy, both home-based and supervised exercise programs have been found to be more effective than no intervention or medication and as effective as minimal comparisons s.e., s.e. functional brace or active comparators e.g. multimodal gynecological surgery.  .
Recently, there has been an increased interest in physical rehabilitation as a means of managing partial and thick rotator cuff tears by specifically addressing weakness and functional deficits. Recent studies have shown that patients who choose therapeutic exercise have shown high satisfaction improvement in function and success in avoiding surgery.
However, optimal indices of exercise and loading such as the mechanism of response to treatment have not yet been established . The intent of the dosage frequency approach to reproduce acceptable pain tolerance inter-exercise activity levels and specific exercise inclusion is not they were able to do so. Further well-designed randomized studies investigating the therapeutic efficacy of exercises for specific shoulder conditions are really needed if criteria for therapeutic exercises are to be determined it is the best. Read more about Therapeutic Exercises for the Shoulder…
Level 2 – Confidence A
- It is effective in terms of short-term relief in rotator cuff disease and long-term functional benefits .
- It is effective for reducing pain and restoring function in impingement (11 trials) .
Evidence suggests that conservative treatment modalities such as manual therapy electrotherapy taping should be avoided as mono-therapy but in some cases may provide some additional benefit when combined with therapeutic exercise programs. The effectiveness of passive treatment modalities can be both a modality and a specific situation.  .
Evidence suggests that manual therapy broadly defined as ..the healing and curative use of hands or the therapeutic use of hands… is beneficial for at least some patients if they have shoulder pain is greatly improved with inclusion exercise but limited evidence as a stand-alone treatment. Manual therapy refers to the use of manipulation (high velocity limiting the range of motion of the joint that moves the joint beyond a passive range) with mobilization (movement of the joint in the appropriate range with movement ) and massage (hand massage soft tissue manipulation or mobilization).
Several reports in the recent peer-reviewed literature indicate that management strategies targeting the cervical and thoracic spine in combination with physical activity provide superior gains in in patients with subacromial and/or rotator cuff related shoulder pain. Positive evidence in this area is limited and further research is needed to determine the extent and nature of the relationship between diaphragm changes and shoulder pain. See your Manual Therapy Techniques for the Shoulder…
Level 2 – Confidence B
- Benefits appear to be mostly short-term, about the same as with injections 
- In the long-term terminal range, high-end is better than low-range, and MWM is better than mid-range 
- Mobilization plus exercise was better than exercise alone, but only during the shortest follow-up period 
- For manual therapy in general with common shoulder diseases excluding arthritis .
The following Case Study examines the role of Manual Therapy for Shoulder Pain;
- How Thoracic Manipulations Help With Shoulder Pain
- Cervicothaoracic Manipulation for Shoulder Pain
The use of taping has been recommended for many therapeutic reasons including modifying joint stability and controlling posture in a joint causing weakness or inhibition of muscle activity improved muscular effort sensorimotor control cutaneous stimulation pain modulation via altered sensory input that increases motoneurone excitability resulting in increased joint torque. and enhance proprioception .
** The use of KT tape with physical therapy has shown some benefit.
Increased thoracic kyphotic forward shoulder posture and chronically elevated scapular forward tilt and downward rotation are associated with forward head tilt or “slack” posture and are thought to result in decreased glenohumeral motion, and Associated with many shoulder disorders. Studies have shown that postural taping produces significantly less forward head posture, less forward shoulder posture, less kyphosis, less scapular lateral displacement, less elevated scapular position, and increased anterior sagittal position Increased pain-free range of shoulder flexion and pain-free range of scapular abduction compared with placebo taping in symptomatic and asymptomatic subjects may contribute to short-term improvement in shoulder flexion and out-of-scapular plane scope of exhibition. 
Level 2 – Confidence D
- Kinesio Tape vs. Kinesio Tape Sham in 42 subjects – Did not help impingement pain .
- 17 baseballers with impingement pain – Increased post scap tilt @ 30 & 60 elevation AND increased from low activity at 60-30 floor .
Electrical stimulants and thermal agents are most commonly used in physical therapy for pain management. However, non-thermal agents such as pulsed ultrasound have been reported to have analgesic effects. Evidence of efficacy of most electrotherapy modalities is limited Management of shoulder pain.
Systematic reviews have consistently concluded that the evidence does not support the effectiveness of laser therapy compared with other interventions.   While low-level laser light (LLL) does not appear to have strong evidence as a stand-alone treatment, there is limited evidence that LLL Reduces pain, is a viable pain-relieving treatment, and therefore may accelerate improvements in physical function by controlling inflammation or stimulating tendon repair, with the end result being less pain and faster improvement when added to exercise-based therapy program. It has also been suggested that LLL may have a more pronounced effect on shoulder function if the pain-relieving benefit is dedicated to optimizing motion parameters.  The study also showed that LLL treatment was a safe and effective pain management option compared to Corticosteroid injections, especially for rotator cuff tendinopathy, should therefore be offered prior to injection therapy.   Further high-quality trials are needed to determine the effects of lasers, especially direct comparisons with drugs. 
Level 2 – Confidence B
- LLL showed significantly better shoulder function at the end of treatment compared to placebo (p < 0.0001) 
- LLL superior to sham LLL
- Short-term (2-week gain) vs. placebo RR 3.71 (1.89-7.28) 
Several current systematic reviews do not support the efficacy of ultrasound when used for shoulder pain (mixed review) adhesive capsulitis subacromial or rotator cuff related shoulder pain. There is some evidence that ultrasound improves compared to placebo when it is primarily used for painful calcific lesions of the rotator cuff.
There is some evidence of pain reduction and functional improvement with shockwave therapy in calcific tendonitis and it has been suggested as an alternative to surgery if it occurs as a management therapy strict controls are ineffective in relieving pain and other symptoms if.    . Another study has shown the benefit of shockwave therapy over conservative physiotherapy for adhesive capsulitis to reduce pain but the results of this study should be interpreted with caution as the conservative physiotherapy intervention was not defined.
- ↑ Moosmayer S Lund G Seljom U, et al. Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: A randomised controlled study of 103 patients with one-year follow-up. J Bone Joint Surg Br. 2010;92(1):83–91.
- ↑ Brox JI, Gjengedal E, Uppheim G, Bøhmer AS, Brevik JI, Ljunggren AE, Staff PH. J Shoulder Elbow Surg. 1999 Mar-Apr; 8(2):102-11.
- ↑ Jump up to:3.0 3.1 3.2 3.3 3.4 Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012 Jun 1;98(2):101-9.
- ↑ Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, Shirkey BA, Donovan JL, Gwilym S, Savulescu J, Moser J. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet. 2017 Nov 20
- ↑ Jump up to:5.0 5.1 Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. International journal of sports physical therapy. 2016 Apr;11(2):279.
- ↑ Jump up to:6.0 6.1 6.2 6.3 6.4 6.5 6.6 Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database systematic Review The Cochrane library. 2006;3.
- ↑ Jump up to:7.0 7.1 Kuhn, John E. “Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.” Journal of shoulder and elbow surgery 18.1 (2009): 138-160.
- ↑ Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. International journal of sports physical therapy. 2016 Apr;11(2):279.
- ↑ Creech JA, Silver S. Shoulder impingement syndrome. InStatPearls [Internet] 2021 Jul 26. StatPearls Publishing.
- ↑ Ainsworth R, Lewis J, Conboy V. A prospective randomized placebo-controlled clinical trial of a rehabilitation programme for patients with a diagnosis of massive rotator cuff tears of the shoulder. Shoulder & Elbow. 2009 Jul 1;1(1):55-60.
- ↑ Haahr JP, Andersen JH. Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years’ follow-up in a prospective, randomized study. Scand J Rheumatol. 2006;35:224-8.
- ↑ Ketola S, Lehtinen J, Rousi T, Nissinen M, Huhtala H, Konttinen YT, et al. No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome: Five- year results of a randomised controlled trial. Bone & joint research. 2013;2:132-9.
- ↑ Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of non- traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. The bone & joint journal. 2014;96-B:75-81.
- ↑ Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Manual therapy. 2016 Jun 1;23:57-68.
- ↑ Yu H, Côté P, Shearer HM, Wong JJ, Sutton DA, Randhawa KA, Varatharajan S, Southerst D, Mior SA, Ameis A, Stupar M. Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration. Physical therapy. 2015 Mar 1;95(3):306-18.
- ↑ Land H, Gordon S, Watt K. Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: a randomized controlled trial. Physiotherapy research international. 2019 Apr;24(2):e1768.
- ↑ Jump up to:17.0 17.1 Favejee, M. M., B. M. A. Huisstede, and B. W. Koes. “Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review.” British journal of sports medicine 45.1 (2011): 49-56.
- ↑ Brantingham, James W., et al. “Manipulative therapy for shoulder pain and disorders: expansion of a systematic review.” Journal of manipulative and physiological therapeutics 34.5 (2011): 314- 346.
- ↑ Host HH. Scapular taping in the treatment of anterior shoulder impingement. Phys Ther. 1995;75:803-812.
- ↑ Macdonald R. Taping Techniques: Principles and Practice. Oxford, UK: Butterworth-Heinemann Ltd; 1994.
- ↑ Mulligan B. Manual Therapy ’Nags’, ’Snags’, ’PRP’s etc. Wellington, New Zealand: Plane View Services; 1995.
- ↑ Schmitt L, Snyder-Mackler L. Role of scapular stabilizers in aetiology and treatment of impingement syndrome. J Orthop Sports Phys Ther. 1999;29:31-38.
- ↑ Jump up to:23.0 23.1 Lewis JS, Wright C, Green A. Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. Journal of Orthopaedic & Sports Physical Therapy. 2005 Feb;35(2):72-87.
- ↑ Kul A, Ugur M. Comparison of the efficacy of conventional physical therapy modalities and kinesio taping treatments in shoulder impingement syndrome. The Eurasian journal of medicine. 2019 Jun;51(2):139.
- ↑ Thelen, Mark D., James A. Dauber, and Paul D. Stoneman. “The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.” journal of orthopaedic & sports physical therapy 38.7 (2008): 389-395.
- ↑ Hsu, Yin-Hsin, et al. “The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome.” Journal of electromyography and kinesiology 19.6 (2009): 1092-1099.
- ↑ Jump up to:27.0 27.1 27.2 Littlewood C, May S, Walters S. A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy. Shoulder & Elbow. 2013 Jul 1;5(3):151-67.
- ↑ Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L. and Struyf, F., 2020. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of orthopaedic & sports physical therapy, 50(3), pp.131-141.
- ↑ Jump up to:29.0 29.1 29.2 29.3 Haslerud S, Magnussen LH, Joensen J, Lopes‐Martins RA, Bjordal JM. The efficacy of low‐level laser therapy for shoulder tendinopathy: a systematic review and meta‐analysis of randomized controlled trials. Physiotherapy Research International. 2015 Jun 1;20(2):108-25.
- ↑ Avancini-Dobrović V, Frlan-Vrgoč L, Stamenković D, Pavlović I, Schnurrer-Luke Vrbanić T. Radial extracorporeal shock wave therapy in the treatment of shoulder calcific tendinitis. Collegium antropologicum. 2011 Sep 25;35(2):221-5.
- ↑ Mangone G, Veliaj A, Postiglione M, Viliani T, Pasquetti P. Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis. Clinical cases in mineral and bone metabolism. 2010 May;7(2):91.
- ↑ Magosch P, Lichtenberg S, Habermeyer P, Ellenbogenchirurgie SU. Radial shock wave therapy in calcifying tendinitis of the rotator cuff-a prospective study. Zeitschrift fur Orthopadie und ihre Grenzgebiete. 2003 Nov 1;141(6):629-36.
- ↑ Kachewar SG, Kulkarni DS. Calcific tendinitis of the rotator cuff: a review. Journal of clinical and diagnostic research: JCDR. 2013 Jul;7(7):1482.
- ↑ Park C, Lee S, Yi CW, Lee K. The effects of extracorporeal shock wave therapy on frozen shoulder patients’ pain and functions. Journal of physical therapy science. 2015;27(12):3659-61.