Rotator cuff related shoulder pain is the most common cause of shoulder trouble, covering things people often hear called impingement or subacromial pain. Exercise is the go-to treatment, but there are lots of ways to exercise a shoulder, so a fair question is which type actually works best. This review set out to answer exactly that.
The authors ran a network meta-analysis, a clever method that lets you compare several treatments at once even when they were not all tested head to head. They pooled 16 randomised controlled trials with 913 people and ranked seven different styles of exercise for their effect on pain and shoulder function.
Shoulder pain is bread-and-butter work in any clinic. Knowing which exercises give the best results helps us build smarter programs rather than guessing.
The trials tested a range of approaches, including concentric strengthening (muscles working as they shorten), eccentric strengthening (muscles working as they lengthen), motor control, scapula-focused work, and high and low load training.
Rather than a simple yes or no, the review ranked the styles so practitioners can see which tended to come out on top.
Strengthening came out ahead, with one style leading the pack.
Concentric strengthening training ranked highest for both reducing pain and improving shoulder function.
Eccentric strengthening and traditional training were solid second-tier options when the top choice did not suit.
Across the board, structured exercise improved rotator cuff shoulder pain and function.
No single program suits everyone, so matching the style to the person is key.
Exercise works for rotator cuff shoulder pain, and strengthening the shoulder, especially concentric strengthening, tended to give the best results across 16 trials. It is a strong case for an active, loading-based approach.
This backs what we do every day, building a progressive strengthening program rather than relying on rest or passive treatment alone. It also reminds us that the details matter, and that a well-chosen, well-dosed strengthening plan is likely to outperform a generic one.
Hands-on treatment still has a place to settle pain and free up movement so you can exercise comfortably, but the research is clear that loading the shoulder is what drives lasting change.
Supports combining hands-on care with progressive shoulder strengthening rather than passive treatment alone.
Directly backs structured strengthening, especially concentric loading, as a first-line approach for rotator cuff shoulder pain.
Reinforces soft-tissue work to ease pain and support an active rehab program.
Complements needling of tight shoulder muscles alongside a strengthening plan.
Some comparisons were based on small numbers, and about a quarter of the trials were rated at higher risk of bias, mostly due to missing data. Follow-up was short to medium term, so we cannot say much about results years down the track. The rankings are a helpful guide rather than the final word.
Across 16 trials, exercise improved rotator cuff shoulder pain and function, with strengthening, particularly concentric strengthening, ranking best. For anyone with a sore shoulder, it is strong encouragement to get moving with the right program rather than waiting it out.
Effects of seven types of exercise in the treatment of rotator cuff-related shoulder pain: a systematic review and Bayesian network meta-analysis. Zhang W, and colleagues. Journal of Orthopaedic Surgery and Research, 2025. Please confirm the full citation at the source before publishing.
