In a 2014 randomized controlled trial researchers found that for mechanical shoulder pain, manual physical therapy is a better choice than steroid injections. Manual therapy can address a common issue implicated in shoulder pain, subacromial impingement (SI). SI is not a diagnosis, but it can and does contribute to the risk of developing long-term or chronic shoulder pain that could result with loss of shoulder function or use.
While SI is not simple to treat, manual therapy is just one of the many tools that a physical therapist has to help manage the condition. In other words, physical therapy has a bigger role in treating shoulder pain than just using manual therapies like joint mobilization, trigger point therapy, dry needling, myofascial release, or soft tissue work.
Physical therapy treatment for shoulder pain includes a range of modalities, and when the PT is an integrative therapist like I am, they can discuss the role of nutrition, inflammation, and use of complementary therapies such as yoga, Tai chi, and acupressure, for starters. A physical therapist can individualize a program based on your specific symptoms, which means that treating SI is not a one-size-fits-all approach. This is one of the many reasons why physical therapy is more effective over cortisone injections.
An injection only diminishes local inflammation, but it does not treat the source of the SI. And further, too many injections can weaken the rotator cuff, tendons, and ligamentous support, leading to further damage and increased pain.
The study followed 104 patients with SI over 1 year in a single-blinded, randomized, controlled trial. The study was able to conclude that manual physical therapy, one of the many treatments a physical therapist can use to treat shoulder pain, was less costly and equally as effective at treating SI. Read more in Manual Physical Therapy – For Shoulder Pain it Should be PT First!