The integration and sequencing of scapular-focused and eccentric exercises in shoulder rehabilitation: a scoping review of combined protocols for RCRSP

Rotator cuff related shoulder pain shoulder pain is a common musculoskeletal condition associated with pain, decreased shoulder function, and impaired quality of life. Eccentric exercise and scapula focused rehabilitation are frequently prescribed. However, their optimal integration and sequencing remain unexplored. Systematic searches of PubMed, Scopus, Web of Science, CINAHL and PEDro (2015-2025) identified randomized controlled trials investigating eccentric exercise, scapular stabilization or combined rehabilitation approaches in individuals with RCRSP. Data were extracted on study characteristics, intervention protocols, outcome measures and key findings. Eight studies met the inclusion criteria, including randomized controlled trials and pilot randomized studies. Eccentric exercise interventions demonstrated improvements in pain, strength, tendon-related outcomes, and functional recovery. Scapular-focused programs showed significant benefits in pain reduction, shoulder function, neuromuscular control, scapular alignment, and movement mechanics. Multimodal approaches combining exercise with adjunct therapies also reported positive clinical outcomes. However, no included study explicitly investigated the combined sequencing of scapular stabilization and eccentric exercise within a single rehabilitation framework. Most studies evaluated these interventions in isolation or as comparative protocols. Both eccentric exercise and scapular-focused rehabilitation are effective in managing RCRSP. However, evidence regarding their optimal integration and sequencing is lacking. A biomechanically informed progression in which scapular stabilization precedes eccentric strengthening may be clinically reasonable, but this hypothesis requires confirmation through high-quality randomized controlled trials.