Discipline of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia Department of Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
Discipline of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia.
Br J Sports Med. 2014 Aug;48(16):1216-26. doi: 10.1136/bjsports-2011-090553. Epub 2012 Jul 26.
To determine the effectiveness of exercise and soft tissue massage either in isolation or in combination for the treatment of non-specific shoulder problems.
Database searches for articles from 1966 to December 2011 were performed. Studies were eligible if they investigated 'hands on' soft tissue massage performed locally to the shoulder or exercises aimed at improving strength, range of motion or coordination; non-surgical painful shoulder disorders; included participants aged 18-80 years and outcomes measured included pain, disability, range of motion, quality of life, work status, global perceived effect, adverse events or recurrence.
Twenty-three papers met the selection criteria representing 20 individual trials. We found low-quality evidence that soft tissue massage was effective for producing moderate improvements in active flexion and abduction range of motion, pain and functional scores compared with no treatment, immediately after the cessation of treatment. Exercise was shown by meta-analysis to produce greater improvements than placebo, minimal or no treatment in reported pain (weighted mean=9.8 of 100, 95% CI 0.6 to 19.0) but these changes were of a magnitude that was less than that considered clinically worthwhile. Exercise did not produce greater improvements in shoulder function than placebo, minimal or no treatment (weighted mean=5.7 of 100, 95% CI -3.3 to 14.7).
There is low-quality evidence that soft tissue massage is effective for improving pain, function and range of motion in patients with shoulder pain in the short term. Exercise therapy is effective for producing small improvements in pain but not in function or range of motion.
确定运动和软组织按摩单独或联合治疗非特异性肩部问题的效果。
对 1966 年至 2011 年 12 月的文献进行数据库检索。如果研究调查了针对肩部的局部“手法”软组织按摩或旨在改善力量、运动范围或协调性的运动；非手术性肩部疼痛性疾病；纳入年龄在 18-80 岁之间的参与者，且测量的结果包括疼痛、残疾、运动范围、生活质量、工作状态、整体感知效果、不良反应或复发，则研究符合入选标准。
有 23 篇论文符合选择标准，代表了 20 项单独的试验。我们发现低质量的证据表明，与无治疗相比，在治疗停止后立即，软组织按摩可使主动前屈和外展运动范围、疼痛和功能评分产生适度改善。荟萃分析表明，运动比安慰剂、最小或无治疗更能产生更大的疼痛改善（加权均数为 100 分中的 9.8 分，95%CI 0.6 至 19.0），但这些变化的幅度小于临床上认为有价值的幅度。运动在肩部功能方面没有比安慰剂、最小或无治疗产生更大的改善（加权均数为 100 分中的 5.7 分，95%CI -3.3 至 14.7）。
低质量证据表明，在短期治疗中，软组织按摩可有效改善肩部疼痛患者的疼痛、功能和运动范围。运动疗法在减轻疼痛方面有效，但在功能或运动范围方面无效。
