Exercise Therapy for Rotator Cuff Tendinopathy : A Systematic Review

Introduction: Shoulder pain is a prevalent musculoskeletal disorder, affecting 16–26% of the population, with rotator cuff (RC) tendinopathy being a leading cause (85% of cases). Despite its high prevalence, only 33–45% of sufferers seek medical care. Conservative management, particularly exercise therapy, remains first-line treatment, though evidence on optimal protocols is limited. Previous systematic reviews have been constrained by methodological weaknesses, including inconsistent diagnostic criteria and variable exercise regimens. Purpose: This systematic review examines exercise-based interventions for RC tendinopathy, focusing on their effectiveness in reducing pain and improving function. Objectives include (1) evaluating current evidence and (2) assessing effects on patient-reported outcomes for pain and function. Method: A systematic review based on randomized controlled trials (RCTs) was conducted according to the PRISMA guidelines. One reviewer conducted a series of searches, between the dates 20241106 and 20241115, in three electronic databases: PubMED, SPORTDiscus and CiNAHL. The methodological quality of included RCTs was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: This systematic review analyzed 11 RCTs (n=817) on exercise interventions for RC tendinopathy. Studies examined various approaches (4-16 weeks duration), including home-based, supervised and combined programs targeting RC and scapular muscles. The Shoulder Pain and Disability Index (SPADI) showed significant improvements across interventions. Pain scores (NPRS/VAS) also improved significantly (p<0.05). While functional measures demonstrated benefits, between-group differences were often non-significant. Risk of bias assessment revealed high risk in 5 studies, some concerns in 3 and low risk in 3. Conclusion: Exercise therapy effectively improves pain and function in RC tendinopathy, though methodological limitations prevent conclusions on optimal approaches. A tailored strategy, considering symptoms, preferences, and functional demands, is recommended over standardized protocols. Future research should prioritize rigorous RCTs with standardized outcomes and biopsychosocial integration (e.g., addressing fear-avoidance).